Changes to the Passport Program

1. Changes to the Passport Program Consultation Slide Deck September/October 2012

2. Purpose The purpose of this session is to: • Provide an overview of proposed changes to the Passport program. • Obtain feedback on key changes to the Passport program: • To include some services previously available through the Special Services at Home program, but not yet available through the Passport program; • To clarify and increase program and financial accountability; and • To align the Passport program with future policy directions for the developmental services transformation.

3. Background – Passport Program • The Passport program was introduced in 2005/06. • There were three components of the Passport program: • Mentoring; • Planning; and • Community Participation Supports. • Most Passport program funding is used to purchase Community Participation Supports. • In 2011/12, the ministry invested about $45 million to support approximately 3,800 individuals.

4. Background – Special Services at Home • The Special Services at Home (SSAH) program was introduced in 1982 to help families who had a child up to 18 years of age with a developmental disability to remain at home. • In 1990, SSAH was expanded to include children with a physical disability (up to age 18) and adults with a developmental disability. • Prior to April 1, 2012, there were two components of SSAH: • Personal Development and Growth; and • Respite. • In 2011/12, the ministry allocated about $103 million for SSAH (for both adults and children).

5. Background – Comparing SSAH and Passport Key Similarities: • There has been considerable overlap between the “personal development and growth” component of SSAH and the “community participation supports” component of the Passport program. Similar supports are provided by both programs (e.g., activities of daily living, personal skill development, hygiene, community outings, etc.). Key Differences: • While caregiver respite for adults with a developmental disability was available through SSAH, it is not currently available through the Passport program. • SSAH has been a directly operated program administered by MCSS regional offices; the Passport program is a transfer payment program administered by developmental services agencies called “Passport Agencies”. • Both programs have their own set of guidelines and have had different accountability and reporting requirements.

6. Background – Transition of SSAH to Passport • In June 2011, the ministry announced that it was moving to a single direct funding program by transitioning the adult portion of the SSAH program to the Passport program on April 1, 2012. • There were several reasons for this transition: • A single direct funding program is a key component of Developmental Services Transformation; • Both SSAH and the Passport program had direct funding components / options; • Many of the services and supports available through SSAH and the Passport program are similar and overlapping; • A single direct funding program would be more administratively efficient than two separate programs. Access for individuals and families would be streamlined; and • The Auditor General observed in the 2011 audit of the ministry’s Developmental Supportive Services that there were similar program and financial accountability issues with both programs. • In response to the Auditor General’s report, the ministry committed to improving program and financial accountability by clarifying what Passport program funding could be used for.

7. Passport – Eligibility and Access • Since July 1, 2011, all individuals seeking developmental services and supports for the first time, including the Passport program, are required to apply at their local Developmental Services Ontario (DSO) organization. • The DSO confirms eligibility and works with the individual and family to complete the developmental services application package. • If the individual/family is seeking community participation supports through the Passport Program, then the DSO provides information about the individual to the Passport Agency who administers this component of the Passport program. • The Passport Agency will complete the Passport Decision Support Guide and determine the amount of funding that the individual is eligible to receive. • If resources are available, the individual/family has the option to receive their funding directly from the Passport Agency (i.e., direct funding), or they can ask the Passport Agency to arrange the services and supports with an agency on their behalf, or a combination of the two.

8. Passport – Eligibility and Access

9. Changes to Passport Guidelines • With the merging of the SSAH and Passport programs, changes are needed to: • Align eligibility and access requirements for the Passport program with requirements in the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008; • Address the differences between the two programs; and • Clarify and increase accountability for funding. • The feedback provided during these discussions will be reviewed and analyzed, and will inform the development of new Passport program guidelines. • For each change, we have identified: • Issue – why change is needed; • Principle – to guide change; • Rationale – why the ministry is pursuing a new/different direction; and • Questions – to help guide discussion.

10. Key Change 1 – Expenditures Issue: • The former SSAH and the current Passport program guidelines have not been completely clear about how funding can and cannot be used. • This has led to differing interpretations of the guidelines and inconsistent approvals and use of funding. • The Passport program is intended to provide funding to enable an individual with a developmental disability to achieve personal goals by accessing and participating more fully in community-based activities. The Passport program is not intended to cover common expenses that are the responsibility of every individual and/or family. Principle for Change: • Passport funding should not be used to cover expenses that all individuals and families have regardless of whether the individual/family member has a developmental disability, or whether the services/supports are provided by another government ministry.

11. Key Change 1 – Expenditures Proposed Direction: • Passport program funding would normally be used to hire a support worker to help the individual access and participate in community-based activities. Without this support, the individual would not be able to access and participate in these activities on their own. • Passport program funding should not be used to purchase goods, services, or fees associated with entertainment, recreation, sports, hobbies, etc. • The ministry will provide a list of admissible and inadmissible expenditures to be clear about what can and cannot be approved. • There is now a greater focus on hiring support workers to assist an individual to accomplish their personal goals through various forms of community participation, rather than the costs related to the activities or programs, which anyone, regardless of ability, may have. • The ministry would establish a process to consider exceptional circumstances, so that funding requests that are outside of the lists of admissible and inadmissible expenditures may be considered. Rationale: • Provides clear direction and removes ambiguity; • Promotes provincial fairness and consistency; • Promotes public accountability; and • Addresses the Auditor General’s concerns.

12. Key Change 1 - Admissible Expenditures The underlying difference in the revised Passport guidelines is the change in approach. The Passport Program will now have a greater focus on hiring support workers to assist an individual to accomplish their personal goals through various forms of community participation, instead of funding direct costs related to the activities or programs.

13. Key Change 1 - Inadmissible Expenditures Due to ambiguities in the current guidelines, direct expenditures such as entertainment (tickets/entrance fees), club memberships, lessons, supplies and equipment may have been approved in the past. The revised guidelines will clearly state that all such expenditures are inadmissible. Only expenses that are related to human resource support for the individual are admissible.

14. Key Change 1 – Questions for Consultation • Is the principle for change clear? Passport funding should not be used to cover expenses that all individuals and families have regardless of whether the individual/family member has a developmental disability, or whether the services/supports are provided by another government ministry. Then agencies should not be able to pay or subsidize these expenses for families. 2. Does the principle align with the list of admissible and inadmissible expenditures? Are there any inconsistencies? • Is there anything missing from this principle? 4. Any other comments on this section?

15. Key Change 2 - Respite Issue: • Respite supports were previously available through SSAH but are not currently available through the Passport program. • Under SSAH, respite supports could be used in two ways: • Direct Supports - providing a break for the primary caregiver(s) from their caregiving role for personal renewal and to strengthen family capacity; and • Indirect Supports: providing assistance to the primary caregiver(s) with normal family responsibilities so that the caregiver(s) can spend more time with their child with a developmental disability. • The SSAH guidelines were not clear on admissible and inadmissible expenditures for indirect respite support. As a result, practices varied widely across the province. • Historically, respite has been understood as primarily a benefit to the caregiver(s) and as a secondary benefit for the individual with a developmental disability. • In the future, there will be greater focus placed on the benefits of respite to the individual with a developmental disability and Passport program funding will focus on supports that the individual needs to achieve their personal goals and outcomes. The respite provided must be meaningful for the individual as well as providing a break to the caregiver.

16. Key Change 2 – Respite Principle for Change: • Respite supports should be used to enable an individual with a developmental disability to achieve personal goals and have positive outcomes while giving the primary caregiver a break from their caregiving role for personal renewal and to strengthen family capacity. This would involve hiring a support worker. Proposed Direction: • Caregiver respite will become available as a support under the Passport program. • Respite is to be primarily a benefit for the individual with a developmental disability to help him or her to achieve their goals and outcomes. • Indirect respite supports would not be admissible expenditures. Rationale: • Allows respite support to be accessed through the Passport program; • Provides clear and consistent criteria for respite funding; • Focuses on benefits for the individual with a developmental disability; and • Helps to address the Auditor General's concerns around use of public funds.

17. Key Change 2 - RespiteExamples of Admissible and Inadmissible Expenditures

18. Key Change 2 – Questions for Consultation 1. Is this principle for change clear? Respite supports should be used to enable an individual with a developmental disability to achieve personal goals and have positive outcomes while giving the primary caregiver a break from their caregiving role for personal renewal and to strengthen family capacity. This would involve hiring a support worker. 2. Do you think the principle is consistent with the proposed direction to include respite as an eligible expense under Passport focusing the benefits of respite on the individual? 3. Is there anything missing from this principle? 4. Any other comments on this section?

19. Key Change 3 – Modernizing Accountability Issue: • Both the SSAH and the Passport program require individuals and families to submit receipts and invoices before they can be reimbursed for expenditures. This process is labour intensive. • With the expansion of the Passport program to include all current adult SSAH recipients, it would be a challenge for Passport Agencies (and, in the future, Developmental Services Ontario organizations) to continue to provide the same level of review, however, the ministry must have a process by which it can ensure funds are being spent as they were intended. Principle for Change: • The ministry is increasing and modernizing accountability for the use of public funds within the Passport program by providing greater clarity regarding admissible and inadmissible expenses, implementing a consistent and enhanced funding approval process, and simplifying the reporting process (less paperwork for individuals and families) while ensuring accountability.

20. Key Change 3 – Modernizing Accountability Proposed Direction: • The proposed program and financial accountability regime includes: • DSO confirms an applicant’s eligibility for developmental services and supports; • The level of funding that an individual/family receives will be determined by the individual’s support needs, the Passport Decision Support Guide, the Passport program guidelines, and the availability of resources. • The Passport Agency will monitor expenditures against the approved planned usage on a quarterly basis; • The individual/family will submit quarterly reports to the Passport Agency for review, approval and/or reimbursement; • The individual/family retains all invoices and receipts for a period of time; and • The Passport Agency conducts random and risk-based audits. • A business process with checks and balances, to ensure that Passport funds are used as planned. In the event of deliberate misuse of Passport funding, action will be taken, including removing a person from the program and/or requiring that the misused funds be repaid. Rationale: • This approach: • Involves less paperwork. • Clarifies, enhances and modernizes accountability.

21. Key Change 3 – Questions for Consultation 1. Is this principle for change clear? The ministry is increasing and modernizing accountability for the use of public funds within the Passport program by providing greater clarity regarding admissible and inadmissible expenses, implementing a consistent and enhanced funding approval process, and simplifying the reporting process (less paperwork for individuals and families) while ensuring accountability. • Is there anything missing from this principle? What about accountability and transparency for families? MCSS should inform all families when funding is available, giving the amount being released. MCSS should publish consistent criteria for selection. Passport agencies should release a) the number of individuals receiving passport and b) the amount of funding each receives, from each agency and region as well as province wide. • What do individuals and families need to understand to manage these program changes? Information on how to self manage funding, thus eliminating administration fees. Spread sheets to facilitate invoicing electronically. Use of email to submit invoices.

22. Other Issues • Are there any other issues that have not been covered? • Review and possibly eliminate the mentoring program • Control the amount of money agencies can charge for administering Passport • Require each Passport agency to advertise and maintain a bank of resumes of potential support workers • Develop a system to release some funding to eliminate the need for families to pay support workers out of pocket and then seek re-imbursement after the fact

23. Next Steps • Community engagement (October 2012) • Review and analyze feedback received (October/November 2012) • Revise Passport program guidelines (November 2012) • Introduce revised Passport program guidelines (December 2012) • Implement revised guidelines (Spring 2013)

24. Contact Us Do you have more feedback to provide? Here’s how to contact us: • By mail: Comments on Changes to the Passport Program Community and Developmental Services Branch Ministry of Community and Social Services 80 Grosvenor Street 4th Floor, Hepburn Block Toronto, Ontario M7A 1E9 • By email: DStransformation.css@ontario.ca • By phone: (416) 327-4954 or toll free 1-866-340-8881 • By fax: (416) 325-5554 or toll free 1-866-340-9112