national trends

1. national trends October 25, 2014 The Arc California CCE and Board of directors meetings

2. major national initiatives • New Home and Community Based Services (HCBS) HCBS Waiver Rules • WIOA Reauthorization • United States Department of Justice Court settlements with Oregon and Rhode Island

3. the reason for the change • CMS’ stated intention in promulgating the final rule was to maximize opportunities for people to have access to the benefits of community living, including receiving services in the most integrated setting and to ensure that Medicaid funding and policy support needed strategies for states in their efforts to meet their obligations under the ADA and the Supreme Court decision in Olmstead v. L.C., 527 U.S. 581 (1999).

4. a little background • 1915 (c) Waiver • 1915 (i) SPA • 1915 (k) option

5. the waiver why and how • States apply to waive Medicaid program requirements to provide services in institutional settings, such as nursing homes and intermediate care facilities for individuals with intellectual and developmental disabilities (ICF/IDD). • These waivers are permitted by Section 1915(c) of the Social Security Act and are called 1915(c) waivers.

6. 1915(i) State Plan Amendment. • HCBS as part of their regular Medicaid program by amending the state plan. • Adding HCBS that normally could be provided through a 1915(c) waiver to their state plan. • Limit services available to people before they need institutional services.

7. 1915(k) Community First Choice (CFC) Option. • States choosing the Section 1915(k) option must make attendant services and supports available to all Medicaid beneficiaries who meet eligibility criteria for the CFC option.

8. What is A HCB Setting? • • You have Full access to community – you can seek competitive work, engage in community life, control personal resources, and receive services in the community like anyone else. • • You are Fully informed of all home living supports and you select it • • You control your privacy and there no coercion or restraints • • You can exercise individual initiative, have autonomy, and independence in making all life and lifestyle choices including getting services and supports and by whom.

9. Provider Residential Settings • •You have the same rights and responsibilities as all home owner or tenant. • • You have privacy as desired in your living or sleeping unit • • Your place has entrance doors lockable by the individual • • You choose your roommate if you choose to share a room • • You can furnish and decorate your own room • • You have can control your own schedule, activities, and food • • You can have visitors when you want • • You can physically access your home

10. What Won’t Pass • Nursing facilities, IMDs, and ICFs • Hospitals providing long term care services • Services in a building that is also a facility that provides inpatient institutional treatment • Services on the grounds of, or immediately adjacent to, a public institution • Services that have the effect of isolating individuals from the broader community

11. The California Plan, So Far… • The compliance determination process includes all of the following: • An initial State-level assessment of standards, rules, regulations, and other requirements to determine if they are consistent with the federal requirements. This will be completed within six months of CMS approval of the Statewide Transition Plan. • This State-level assessment will be conducted jointly by DHCS and the State Department(s) responsible for operating each Waiver with stakeholder input. • Results of this assessment will be available for public comment and will be used to determine and develop the remedial strategies that may be necessary to ensure that all HCB settings conform to the federal requirements. • In addition to the State-level assessment, on-site evaluations of individual settings will be conducted as follows: • On-site evaluations will be conducted at all settings that, per CMS guidance, are presumed not to be HCB settings. • For all other settings, a representative random sample of on-site evaluations will be conducted. • It is anticipated that the on-site evaluations will be completed within one year of CMS approval of the assessment tool.

12. …CA Plan… • The on-site evaluations will be conducted by a survey team that includes one or more of the following: State personnel, service recipients or their family members, case managers or other representatives of case management entities, representatives of consumer advocacy organizations, and/or other stakeholders. • The responsibility for ensuring completion of these evaluations rests with the program staff as specified under the “Overview of State Responsibility” section of this document. The State will support the provision of training for all participants of survey teams to ensure that HCB settings are built around the person-centered plan approach and are compliant with the new federal requirements. • DHCS will develop an assessment tool for use in the on-site evaluations of HCB settings. The assessment tool will include each new federal requirement that will be used to determine if the HCB setting meets or does not meet the required federal rule. The completed assessment tool will be maintained in the appropriate State file for each waiver and will be used to verify compliance at the time of CMS renewal of the HCBS waiver. Note: this assessment tool shall be developed and circulated for stakeholder comments no later than 60 days after CMS approval of this Statewide Transition Plan. • The assessment tool will be forwarded to each HCB setting selected for evaluation with instructions to complete a s elf-assessment prior to the evaluation completed by the survey team. The completed assessment will be forwarded back to the Waiver program for review. • Using the completed assessments, each selected HCB setting (selected from the list identified under the “California Plan for Determination of HCB Setting Compliance” subsection of this document) will be evaluated by a survey team described above.

13. …CA Plan… • Written results of each survey will be forwarded back to the HCB setting with specific information regarding improvements that will be required in order to come into compliance with the federal requirements and a timeline for completion. • Completed assessments for all settings, including documentation of any required follow-up actions as a result of the on-site evaluations, will be maintained in the appropriate State file for each waiver. • An appeal process, to be developed, which allows the HCB setting to dispute the HCB setting’s compliance or the need to comply with the specific requirement when the HCB setting determines the requirement is not applicable to the particular setting. Note: the appeal process shall be developed and circulated for stakeholder comments no later than 60 days after CMS approval of this Statewide Transition Plan. • All State-level and individual setting level remedial actions will be completed by no later than March 17, 2019. • Progress on completion of this Statewide Transition Plan will be monitored at least every six months and will include public posting on the status with opportunity for public input.

14. Workforce Innovation and Opportunity Act • From Workforce One • September 2014

15. Overview of the Workforce Innovation and Opportunity Act • President Barack Obama signed WIOA into law on July 22, 2014. • Passed by Congress with wide bipartisan majority (The Senate voted 93-5 and the House of Representatives voted 415-6). • Reaffirms ongoing role of American Job Centers. • Promotes program coordination and alignment of key employment, education, and training programs at the Federal, State, local, and regional levels. • Builds on proven practices such as sector strategies, career pathways, regional economic approaches, work-based training. • Complements and supports the President’s Job-Driven Workforce Vision.

16. Programs under the Workforce Innovation and Opportunity Act • Supersedes the Workforce Investment Act of 1998 and retains and amends the Adult Education and Family Literacy Act, the Wagner-Peyser Act, and the Rehabilitation Act of 1973. • Identifies “core programs”: • Adults, Dislocated Workers, and Youth formula programs and Wagner-Peyser employment services administered by the Department of Labor; and • Adult education and literacy programs and Vocational Rehabilitation state grant programs that assist individuals with disabilities in obtaining employment administered by the Department of Education. • Authorizes the Job Corps, YouthBuild, Indian and Native Americans, and Migrant and Seasonal Farmworker programs, and evaluation and research activities conducted by DOL.

17. Highlights of Reforms to the Public Workforce System under the Act • Requires states to strategically align workforce development programs to support job seekers and employers. • Promotes accountability and transparency of programs. • Fosters regional collaboration to meet the needs of regional economies. • Streamlines and strengthens the strategic roles of workforce development boards. • Enhances services provided to job seekers and employers through the American Job Center system. • Improves services to employers and promotes work-based training.

18. Highlights of Reforms to the Public Workforce System under the Act • Provides access to high quality training • Enhances workforce services for the unemployed and other job seekers. • Improves services to individuals with disabilities. • Makes key investments in serving disconnected youth and other vulnerable populations, including Native Americans and Migrant and Seasonal Farmworkers. • Increases the performance and quality of the Job Corps program. • Reinforces connections with Registered Apprenticeship.

19. Provisions Related to Disability • WIOA increases individuals with disabilities’ access to high quality workforce services and prepares them for competitive integrated employment. • One-Stop career centers will provide physical and programmatic accessibility to employment and training services for individuals with disabilities and implement new Section 188 (non-discrimination) requirements related to: • functions of the local boards. • local plan content. • certification, at least every three years, of the One-Stop career centers to include an assessment of physical and programmatic accessibility in accordance with Secton188.

20. Provisions Related to Disability • The unified state plan must include all the core programs, including Vocational Rehabilitation (VR) and Adult Education. Among the requirements for the unified state plan is to: • describe how the one-stop delivery system will comply with Section 188 (non-discrimination) regarding physical and programmatic accessibility of facilities, programs, services, technology, and materials for individuals with disabilities. • Youth with disabilities will receive extensive pre-employment transition services so they can successfully obtain competitive integrated employment.

21. Provisions Related to Disability • Supports disconnected youth, of which youth with disabilities comprise a high percent, by: • Requiring local areas to increase percentage of youth formula funds used to serve out of-school youth to 75% versus 30% under WIA. • Requiring local areas to spend at lest 20% of youth formula funds on work experience activities. • Providing additional allowable activities including financial literacy education and entrepreneurial training.

22. Provisions Related to Disability • State vocational rehabilitation agencies will set aside at least 15% of funding to provide transition services to youth with disabilities. • Local workforce development boards may designate a standing committee to: • provide information and assist with operational and other issues related to compliance with non-discrimination and applicable accessibility requirements. • provide input regarding appropriate training for staff on these issues.

23. Provisions Related to Disability • Establishes a committee to advise the Secretary of Labor on strategies to increase competitive integrated employment for individuals with disabilities. • Includes Office of Disability Employment Policy, Wage and Hour Division, and ETA.

24. Technical Assistance Tools and Resources • Department of Labor • WIOA Resource Page (www.doleta.gov/WIOA) • WIOA Dedicated Email (DOL.WIOA@dol.gov) • Department of Education • Office of Career, Technical, and Adult Education’s WIOA Resource Page (http://www.ed.gov/AEFLA) • Rehabilitation Services Administration’s WIOA Resource Page (http://www2.ed.gov/about/offices/list/osers/rsa/wioa-reauthorization.html)

25. Settlement agreement – Rhode Island • People will be provided services to introduce them to work in integrated settings • Annual Person-Centered planning (from age 14) will include opportunities for integrated work and post-secondary work in integrated settings and no later than the school year of 18th year will be offered supported employment and integrated day services. • The state will no longer provide placement or funding for new clients in sheltered workshops. • The State will provide career development plans • Benefits counseling will be provided and supported employment and integrated day services placements • All planning presumes capacity for integrated work. • Anyone who chooses a sheltered workshop, enclave, mobile work crew, internship, facility based program, etc must complete vocational assessment, complete one work trial, receive education and outreach,

26. If you choose segregated services… • Anyone who chooses a sheltered workshop, enclave, mobile work crew, internship, facility based program, etc must: • complete vocational assessment, • complete one work trial, • receive education and outreach, • receive benefits counseling, • reassessed in 180 days and annually thereafter

27. Integrated Day Services • When not in supported employment or other integrated work (within a 40 hour week) the services will be: • individualized, • flexible, • include group and non-group setting, • tailored to their interests, • abilities and goals, • not provided as part of the sheltered workshop services, day program, group home, or other residential setting.

28. ADA & Rehab Act… • Oregon unnecessarily segrated PWD in sheltered workshop, violated: • ADA Sec 2 (discrimination on the basis f disability by public entities) and • the Rehab Act. (discrimination on the basis of disability by entities that receive federal financial assistance)

29. Oregon, The Feds Charge… • Sheltered workshops are by definition segregated. • Oregon has created an expectation for sheltered work • Supported Employment is an effective integrated work program but the state failed to provide “meaningful access” to SEP but over relies on Sheltered Work. • Workshop continues historic isolation of PWD. • The court agreed that the integration regulation extends to employment • Burdensome criteria and methods of administration for selection of SEP • Violated LRE requirements in transition planning in IDEA

30. Findings… • 52% earn less than $3 • 61% People in Sheltered work/16% SEP etc • 57% hours in Sheltered Work/ 10% in SEP etc • Sheltered Work increased Sep etc. declined • 71% facility based programs • Schools are operating sheltered work and transitioning students to adult sheltered work • It costs Oregon 3 times as much to support PWD in Sheltered worked as opposed to SEP