Seniors and People with Disabilities Division James Toews, Director April 2009

1. Seniors and People with Disabilities DivisionJames Toews, DirectorApril 2009

2. Seniors and People with Disabilities Division DRAFT • Day 1, April 15: Introduction and description of SPD services • Day 2, April 16: SPD budget • Day 3, April 20: Major program area – Services to Seniors and People with Physical Disabilities • Day 4, April 21: Major program area – Services to People with Developmental Disabilities • Day 5, April 22: Public testimony • Day 6, April 23: Major program area – Program Support and Central Administration, Wrap-up

3. SPD Mission The mission of the Seniors and People with Disabilities Division (SPD) is to assist seniors, and people with disabilities of all ages, achieve well-being through opportunities for community living, employment, family support and services that promote independence, choice and dignity.

4. SPD goals • Help seniors and people with disabilities remain as independent as possible • Help sustain seniors and people with disabilities with the supports they need to maintain quality lives in their home communities • Honor choices made by seniors and people with disabilities about their own lives • Promote value-driven commitments in statute and policy • Partner with advocacy groups, commissions and councils, local government partners, and community services

6. Seniors and People with Physical Disabilities Eligibility for Medicaid, food stamps Case management services Older American Act services In-home services Community-based facility and nursing facility services Disability determination services (SSA Title II and XVI) APD services

7. Seniors and People with Physical Disabilities 18,000 individuals age 65 and older receive long-term services under Medicaid 26,500 individuals (including people with physical disabilities) receive long-term services under Medicaid monthly 76,200 seniors and people with disabilities receive medical coverage and/or food stamps Who receives APD services

8. People with developmental disabilities Eligibility for developmental disabilities services Case management for children and adults Family support for children Support services for adults Community-based care services for children and adults DD services

9. People with developmental disabilities 17,300 children and adults with developmental disabilities receive case management services 6,100 children and adults with developmental disabilities receive comprehensive services 6,100 adults with developmental disabilities receive in-home support services 1,400 children with developmental disabilities receive family support services Who receives DD services

10. SPD and its partners license: 1,847 relative adult foster homes, consisting of 79 percent Medicaid 1,713 commercial adult foster homes, consisting of 7,174 beds, 38 percent Medicaid 205 assisted living facilities, consisting of 13,790 beds, 28 percent Medicaid 229 residential care facilities, consisting of 8,622 beds, 26 percent Medicaid 141 nursing facilities, consisting of 12,462 beds, 40 percent Medicaid SPD licensing

11. SPD and its partners license and certify: 574 residential sites (24-hour) 31 children’s residential sites (24-hour) 86 employment and alternative-to-employment agencies 56 supported living agencies 6 proctor foster agencies 719 adult foster care providers 248 child foster care providers 118 agencies in Oregon that are licensed or certified to provide services to individuals with developmental disabilities SPD licensing

12. By 2010 – 13 percent of Oregon’s population will be 65 or older By 2030 – 20 percent of Oregon’s population will be 65 or older By 2010 – 76,000 Oregonians will have reached age 85, and by 2030 the number is expected to reach 120,000 25 percent need assistance with ADLs from family or paid caregivers 20 percent need assistance with three or more ADLs Many “spend down” their assets and cannot afford long-term services Many rely on Medicaid for their long-term services Growing need for APD services

13. The state’s changing demographics Lack of provider capacity Decrease in Medicaid capacity in community settings The need to realign Medicaid services to allow individuals with significant needs to be served in community settings Continued need to provide protection for vulnerable adults Recruitment and retention of a long-term care workforce Challenges facing APD

14. Today there are more than 17,000 adults and children with DD enrolled in case management services During 1998 there were 2,700 individuals with DD receiving home and community-based waiver services In-home services expanded as part of the Staley agreement Now nearly 12,000 adults with DD receive support or comprehensive services The number of Oregonians with DD needs such as autism, alcohol- and drug-related causes is growing The Centers for Disease Control estimates 1 in 100 children is diagnosed with autism The need for DD services has grown by 800 every year for the last four years for both children and adults Growing need for DD services

15. Supporting children and families Provider stability County stability Rate setting and assessments Final implementation of the Staley settlement agreement Challenges facing DD

16. DHS Transformation Initiative Fundamentally changing the way business is done SPD already is producing early results SPD is being challenged to do business better within existing resources SPD continuous quality improvement efforts

17. Efforts of quality improvements have included: Financial eligibility intake process (SPD/AAA field and central offices) Presumptive Medical Disability Determination Team process improvement Developmental disability contract administration Corrective Action Unit SPD continuous quality improvement efforts

18. The economy Demographics Population changes Federal policy and funding Automatic Verification System (AVS) Federal Stimulus (ARRA) limitations Medicare services Medicare Improvement for Patients and Providers Act (MIPPA) Major caseload and budget drivers

19. Aged and Physically Disabled caseload trends

20. Forecast changes to EBL

21. Forecast changes to EBL

22. Aged and Physically Disabled by care settings

23. Developmental Disabilities caseload trends

24. Developmental Disabilities by care settings

25. Caseload model looked only at the number of cases to determine staff need The new workload model looks at the actual activity (time) required for the job The workload models were developed by Public Knowledge and McKinsey Future budget documents and rebalance displays will rely on the more accurate workload/staffing comparisons Workload staffing gap

26. Workload staffing gap

27. Workload staffing gap

28. SPD MEBL program budget

29. SPD 2009-2011 base budget to MEBL

30. SPD MEBL by fund type

31. SPD MEBL Federal Funds

32. SPD MEBL Other Funds

33. Services to Seniors and People with Physical Disabilities (DD)

34. 2009-2011 APD budget comparisons

35. Services to People with Developmental Disabilities (DD)

36. 2009-2011 DD budget comparisons

37. Program Support

38. 2009-2011 Program Support budget comparisons

39. Governor’s Recommended Budget

40. Policy Option Package 123: Improving Quality of Long-Term Care This POP creates a Long-Term Care Quality Fund separate from the General Fund. Funds are appropriated for the purpose of regulatory compliance, enforcement and providing technical assistance for nursing facilities, residential care facilities, residential training facilities and residential training homes. Increases state civil penalties collected from LTC facilities not in compliance and places state civil penalties into the Long-Term Quality Care Fund dedicated for use for regulatory and compliance or enforcement activities. Increases annual licensing fees for long-term care facilities to fund the Long-Term Care Quality Fund. Increases compliance monitoring staff by four positions. GRB – Proposed investments

41. Policy Option Package 143: Expedited Trustee Fund This POP enhances the tool used to protect residents in facilities by modifying the grounds for the court to order appointment of a temporary trustee when residents are at risk and in order to prevent immediate evacuation of residents. Increases the amount of current assessments to nursing facilities and community-based care facilities to increase the current Facilities Trust Fund account balance from $300,000 to $500,000. Funds are used to pay for trustee services and continue paying for operating expenditures such as electrical, heat, water, supplies and food services. Current statute allows for a trustee to be requested and appointed when the health and welfare of residents in a facility are in jeopardy, but court appointment of trustees can take several days to weeks. This allows DHS to petition for the expedited appointment of a trustee in emergency situations. This will strengthen the department’s ability to respond quickly when faced with emergency situations and will allow the department to take over management of troubled facilities. GRB – Proposed investments

42. Oregon stimulus package update 2007-2009: Stimulus $88 million 2009-2011: Stimulus $218 million December 2010: Stimulus expires SPD GF fund shift FMAP changes Outstanding Federal Funds issues

43. CBC rate increase $260 per month, April 2009 Memory care contracted rates DD provider rates 14 percent rate increase to DD providers 10 percent increase to employment $260 per month to DD adult foster homes 2007-2009 investments

44. Grants: Money Follows the Person – Oregon “On the Move” CMS Real Choices-Hospital Discharge planning/ADRC Restructuring, budget, assessment and rates (ReBAR) AOA grants Chronic disease management Nutrition, healthy living, exercise NF Diversion and Transition (management action) DD county infrastructure, APS, eligibility EOTC fund transfer (SIS – ReBAR) CNA staffing 2007-2009 investments

45. Reductions – APD ($ 3.0) million GF reduces 4 percent personal services, six month hiring freeze ($ .4) million GF reduces 2 percent services and supplies and Attorney General fees ($26.0) million GF eliminates all inflation ($ 2.5) million GF reduces HCW training and HUBB overpayment for HCW health insurance reserve ($23.0) million GF reduces in-home care less than 80 hours Governor’s Recommended Budget

46. Reductions – APD ($ 6.3) million GF eliminates HCW health insurance for less than 30-hour work week, 120 hours per month ($ .3) million GF eliminates RSVP – Retired Senior Volunteer Program ($ .8) million GF eliminates SHIBA – Senior Health Insurance Program ($39.0) million GF reduces NF reimbursement via cost containment ($ 3.5) million GF savings from NF diversion to community care settings ($99.0) million GF implements “i” state plan amendment, eligibility changes Governor’s Recommended Budget

47. Reductions – DD ($ 2.5) million GF reduces support for DD Housing development and maintenance ($ 3.0) million GF reduces DD Employment Community Inclusion Program ($ 1.5) million GF savings from JPSRB secured facilities development ($ 0.5) million GF savings in DD children’s in-home services ($ 1.6) million GF reduces DD NF special services and special projects Governor’s Recommended Budget

48. Reductions – DD ($ 6.0) million GF reduces DD Family Support Program ($ 9.0) million GF reduces DD CDDP comprehensive 24/7 services for 130 clients and local administration ($ 6.0) million GF reduces DD brokerage community-based support services for 700 clients and local administration Governor’s Recommended Budget

49. Services to Seniors and People with Disabilities (APD) Services to People with Developmental Disabilities Program Support and Administration SPD major programs

50. Seniors and People with Disabilities (APD) Overview James Toews, Director April 2009