Developmental Disabilities Administration Resource Coordination Services

1. Community Developmental Disabilities AdministrationResource Coordination Services Employment Performance Outcomes Quality Assurances Monitoring Quality Holistic Coordination Training #1 June 5, 2012 Funding RC Services

2. Agenda • Welcome • Quality Framework and Continuous Quality Improvement • Resource Coordination Service Framework FY 2013 • Process, Policies, and Forms • Updates • Helpful Strategies • Reminders • Performance Measure Links *Please make a note or flag topics you would like to see more in-depth training

3. Welcome By: Stanley Butkus DDA Deputy Director

4. Resource Coordination Helpful information • What resource coordination is (and isn’t) • How it works • Key functions • Connections to services • Interagency activities • Responsibilities Stanley Butkus

5. Resource Coordination – the why • Assist and support individuals in leading life of quality and meaning to them. • Be realistic but understand that a person is not the sum of their deficits and diagnosis. • We deal with the whole person and the standard is how would we want to be treated in similar circumstances.

6. Resource Coordination – the why • For all the good work of agencies, networks and systems and the wise guidance of policies, procedures and funding formulas; we are ultimately dealing with people’s lives, individual biographies. And we do it one person at a time. • Resource coordination is: • the face of the service system for the person and those people who are important in their lives; • the eyes and ears of our system; and • the first level of monitoring.

7. Resource Coordination – the why • No two people or those in their lives are the same. • There may not be agreement between the person and their family members about what is best or appropriate which can be a source of conflict. • Some are very involved some are distant, even disengaged in some situations. • There may be some situations where you are as close as it gets to being a family member.

8. Resource Coordination – the why • The resource coordinator is the agent of the person, an advocate and problem solver. • A connector through the individual plan to their communities. • One expert in our field ( David Pitonyak) has said that the biggest problem people with intellectual and cognitive disabilities face is loneliness. • You may be able to think of situations in your own life where something was just beyond your grasp intellectually and when there is no one there to check in with you can feel alone-IT does this to me.

9. Resource Coordination – the why • Resource coordinators are independent of agencies providing other services. • This provides the opportunity to act and advocate in concert with the wishes and best interests of people when there are issues that need to be addressed. • The resource coordinator serves expressive and instrumental roles that vary by time and circumstance. • Expressive in the sense of providing emotional and empathic support and instrumental in making sure that as needed the person is supported appropriately residentially, in day and employment situations and for related needs.

10. Resource Coordination – the why • Essential role is the resource coordinator’s connection to the plan. • Developing a plan that is authentic to the person, identifying how life goals will be met taking needs and preferences into account and overseeing, and monitoring progress is at the heart of resource coordination. • In other words, assuring that people get what they need, when they need it, by people who know what they are doing. Matching person needs with care and service provider strengths/preferences for those they serve and support is the key to success. Cross training has its place but everybody cannot work well with everybody.

11. Resource Coordination Daily Commitment • Listen to understand the person’s story • Hold the person in positive regard- because any of us are capable of doing anything (good or bad) that anybody else did in human history if we were in a similar circumstance. • Begin where the person is • Use a positive behavior supports frame

12. Resource Coordination Daily Commitment • Expectations-overtime we have as a field systematically underestimated what people with disabilities can achieve. As we have learned better approaches they have done better. Conversely, with the best of intentions we have expected them to be better citizens than the rest of us-not make any mistakes-creating the unintended consequence of increasing dependency. • Sensitivity to diversity, and socio-economic factors, e.g. 49% of waiver recipients in the US have a family income of less than $25,000 per year

13. Resource Coordination Daily Commitment • These are stressful jobs. • You need to take care of yourself. Burnout occurs when what you want to is out of reach with what you can do. • Be clear on what your functions are and stick to those. • Seek guidance from your supervisor on how to prioritize when you get overloaded. • Know the rules, processes, assurances, and resources and seek additional training or advice. • Someone once said the only place in town where there is no conflict is in the cemetery so if you get a chance get some training in conflict resolution and mediation.

14. DDA Philosophy • People with developmental disabilities are valuable and contributing members of their community. • People and families should have access to necessary services and supports, from various resources, in the least restrictive, most appropriate, and most effective environment possible.

15. DDA Service Delivery Overview • DDA provides a coordinated service delivery system so that people with developmental disabilities receive appropriate services oriented toward the goal of integration into the community.

16. DDA Service Delivery Overview • DDA services are provided through both State and federal funding and programs provided by a wide array of community-based services delivered, State Residential Centers (SRC), and Forensic Residential Centers (FRC).

17. DDA Service Delivery Overview Resource coordinators must: • Be familiar with and maintain compliance with these State and federal laws and regulations, which may be amended during the upcoming fiscal year; • Be knowledgeable and trained in DDA’s: • Waiver and State funded procedures and quality assurances; and • Priorities and initiatives.

18. DDA is committed to coordinating services and supports that are: • Individualized, reflecting a continuum of services and/or supports, both formal and informal, based on the unique strengths of each person and their family/caregivers; • Provided in the least restrictive, most natural setting appropriate to meet the needs of the person and family; • Person directed; • Family-driven and child/youth-guided, with families, children, and youth engaged as active participants at all levels of planning, organization and service delivery;

19. DDA is committed to coordinating services and supports that are: • Community-based, coordinated and integrated with various services and supports including generic (i.e. services available to the public at large), community, local, federal, and State programs for needed medical, social, educational, and other services including community housing agencies, connecting the person with self advocacy groups, recreation, social, and DDA services; • Culturally and linguistically competent, with agencies, programs, services and supports that are responsive to the cultural, racial and ethnic differences of the populations we serve; • Prevent and reduce crisis, emergencies, hospitalization, and institutionalization;

20. DDA is committed to coordinating services and supports that are: • Holistic including generic, local, State, federal, and other resources and funding beyond DDA; • Promote integration with the community at large; • Protective of the rights of children, youth, adults, and their family/caregivers; and, • Collaborative across long term services and support systems, involving Medicaid and other insurances, mental health, child welfare, juvenile services, education, substance abuse, somatic health and other system partners who are responsible for providing services and supports to people eligible for DDA funding.

21. Waiver Roles & Responsibilities • Person – self determination and self-directed (if desired) • Resource Coordinator • Initial application • Service planning – holistic • Monitoring – proactively monitoring services, due dates (plan, LOC, financial redetermination, etc.) circumstances, and needs • Eligibility –annual requirements including Medicaid Financial documentation, LOC, annual plans within 365 days, • Support Broker – Human Resource functions • FMS – Accounting and payroll functions • Service providers – staff that work for the waiver participant

22. Continuous Quality Improvement The DDA is committed to conduct ongoing system-wide reviews of ways to improve the effectiveness of services and supports so people can achieve personally developed outcome through: • better coordination and delivery of services; • accountability of funding; • federal assurances; and • alignment of priorities and strategies.

23. Continuous Quality Improvement • This commitment includes strategies to continuously support DDA’s system of highly qualified and resourceful resource coordinators that are knowledgeable of community resources and creative problem solvers to assist people with becoming fully integrated in their communities.

24. Continuous Quality Improvement • Linking people and families to natural and informal networks leads to improved outcomes and reduced reliance on formal services. • These linkages are essential to be fully integrated in one’s community.

25. Continuous Quality Improvement Quality and the cost of service are both important and inter-related.

26. Continuous Quality Improvement • Lack of monitoring of quality of services may negatively impact health and safety and progress toward goals. • Poor planning and lack of brokering community resources, to include natural supports, may over commit funding for one person which deprives another person of needed services. • It is also true that failing to seek funding in the interest of “cost savings” may impede health and safety, quality, and increase cost pressures in other parts of the system (such as emergency rooms and institutions).

27. DDA Resource Coordination Core Service Categories

28. System Governance and Regulations State and federal statutes and regulations govern the DDA service delivery system. CMS stands for the Federal Center for Medicaid and Medicare Services

29. Medicaid Waiver Basics Background • Community Pathways and New Directions are both Medicaid programs referred to as 1915 (c) Home and Community-Based Service (HCBS) waivers. • Medicaid is a joint federal/State funding program that pays for most long term care provided to low income, older persons and persons with disabilities. • The HCBS waiver allows states to use Medicaid funding to provide services and supports to persons living in their homes or in other community-based settings (e.g. group homes, alternative living units, IFC (DDA’s adult foster homes)). Reference: CMS Training for Case Managers on HCBS Waiver Assurances Link: http://www.hcbsassurances.org/index.html

30. Waiver Basics - continued • Persons are eligible to receive HCBS waiver services if they meet federal qualification criteria. • A state must apply to the CMS through an HCBS waiver application for permission to operate an HCBS waiver. • Regardless of the HCBS waiver design, every application must address how a state intends to meet specific CMS requirements known as the HCBSwaiverassurances. • The assurances were put into place by Congress to address the unique challenges of assuring the qualityof services delivered to vulnerable persons living in their community. Reference: CMS Training for Case Managers on HCBS Waiver Assurances

31. Waiver Basics - continued HCBS Waiver programs must include the following: Reference: CMS Training for Case Managers on HCBS Waiver Assurances

32. Waiver Basics - continued • Waiver Design: The population and geographic area to be served, the mix of services offered, the quality standards, including provider qualifications, policies and payment methods. • Performance Measures: The standards a state will use to evaluate how well the HCBS waiver is meeting each of the federal assurances and subassurances. Reference: CMS Training for Case Managers on HCBS Waiver Assurances

33. Waiver Basics - continued • Discovery Methods: The data a state collects to measure how well it is meeting each performance measure; the method and frequency of data collection and analysis; and the person or entity responsible for using the data for decision-making. • Remediation: How a state will take action when individual problems are found. • System improvement: Method to prevent similar problems from happening to others or to make the HCBS waiver more effective and efficient. Reference: CMS Training for Case Managers on HCBS Waiver Assurances

34. Remediation • Focus of remediation is to address and resolve all individual problems uncovered in the course of discovery. • The rate of compliance is measured through the waiver’s performance measures. • CMS expects states to be in compliance with the statutory assurances. • If a performance measure indicates that the state achieved less than 100% compliance, the state must remediate all instances of non-compliance discovered.

35. HCBS Waivers are: • Person centered; • Encourage people to play active roles in deciding the services they want to receive and when; and • Can make a big difference in the person’s and families quality of life. Reference: CMS Training for Case Managers on HCBS Waiver Assurances

36. QA? Challenges in assuring quality in home-based settings Delivering services in home and community settings raises new challenges to assure the quality of these programs. • There is no one on site to monitor care and services at all times. • Participants rely on many people for their care and safety. • Participants may be vulnerable and unable to seek help. • People may be afraid of losing their services if they report problems. So what are the assurances, and how do they relate to you? Reference: CMS Training for Case Managers on HCBS Waiver Assurances

37. Federal HCBS waiver assurances

38. Federal HCBS waiver assurances Level of Care: Participants enrolled in the HCBS waiver meet the level of care criteria consistent with those residing in institutions. Service Plan: A person's needs and preferences are assessed and reflected in a person-centered service plan. Qualified Providers: Agencies and workers providing services are qualified. Reference: CMS Training for Case Managers on HCBS Waiver Assurances

39. Federal HCBS waiver assurances Health and Welfare: Participants are protected from abuse, neglect and exploitation and get help when things go wrong or bad things happen. Financial Accountability: A state Medicaid Agency pays only for services that are approved and provided, the cost of which does not exceed the cost of a nursing facility or institutional care on a per person or aggregate basis (as determined by the state). Administrative Authority: A state Medicaid Agency is fully accountable for HCBS waiver design, operations and performances Reference: CMS Training for Case Managers on HCBS Waiver Assurances

40. Federal HCBS Subassurances Examples Reference: Understanding Medicaid Home and Community Services: A Primer, 2010ase Managers on HCBS Waiver Assurances (PDF Version: http://aspe.hhs.gov/daltcp/reports/2010/primer10.pdf (253 PDF pages))

41. Federal HCBS waiver assurances

42. Maryland’s DD WaiversFederal Assurances Performance Measures Performance Measures

43. Performance Measures *Performance Measures for both Community Pathways and New Directions Waivers

44. Performance Measures *Performance Measures for both Community Pathways and New Directions Waivers

45. Performance Measures *Performance Measures for both Community Pathways and New Directions Waivers

46. Performance Measures *Performance Measures for both Community Pathways and New Directions Waivers

47. Performance Measures *Performance Measures for both Community Pathways and New Directions Waivers unless otherwise indicated.

48. Performance Measures *Performance Measures for both Community Pathways and New Directions Waivers unless otherwise indicated.

49. Performance Measures *Performance Measures for both Community Pathways and New Directions Waivers unless otherwise indicated.

50. Performance Measures *Performance Measures for both Community Pathways and New Directions Waivers unless otherwise indicated.