Mission Possible September 26, 2013

1. Mission PossibleSeptember 26, 2013 Mike WilldenDirector, Nevada Department of Health and Human Services

2. ADSD Legislative approved total revenue

3. ADSD Legislative Approved General fund

4. ADSD Timeline • 2001 2003 2005 2007 2009 2011 2013 Where have we been?

5. 2000 • Olmstead Ruling Published • ADA prohibits states from unnecessarily institutionalizing persons with disabilities. • People should be serviced in the most integrated setting

6. 2001 Session • Strategic Plan for People with Disabilities Authorized by Legislature • Number 1 in the Nation with Disabilities Growth (157% growth over prior decade) • Lack of Integrated Services Available • Information Systems Lacking • Need to Expand Waivers/Community Options • Children Needing Services (Behavioral Health/Autism called out)

7. 2001 Session (continued) • Strategic Plan for Senior Services Authorized by Legislature • Rapid Growth in Senior Population (56% over prior decade vs 35% general population) • Information Systems Lacking • Need for more Community Services • Flat Funding of Services

8. 2003 Session • General Fund $$ Added to Senior Rx Program ($2.8M) due to Rapid Growth – Senior Rx Discount Program also authorized ($300K) • Disability Rx Program Created (2.5% of Tobacco $$) • Office of Disability Services established in DHHS Director’s Office transfer from DETR • Community Based Services and Developmental Disability Budget transferred – goal to centralize services. • Facility oversight and Community Integration Services (FOCUS) started in 2003. • Personal Care Services (PCS) started as an expanded state plan service in 2003.

9. 2003 Session (continued) • AB 395 passed creating quality of nursing care account (6% Provider Tax) • AB 164 passed imposing surcharge on telephone access lines to provide telecommunication devices to persons with impaired speech or hearing. • SB 174 passed transferring $1.1M from Aging Services to OCBS to fund personal care assistant service – finding that OCBS was not properly funded. • Health Insurance for Work Advancement (HIWA) approved allowing Medicaid Coverage for employed disabled through a buy-in mechanism.

10. 2005 Session • AB 524 passed to coordinate Senior Rx with Medicare Part D Rx coverage effective January 1, 2006. Senior Rx converted from “insured” to “self-insured” model • AB 284 passed establishing Assisted Living Waiver (7/1/06) • Developmental Services initiated pilot program to provide assistive payments averaging $1,100/month to 52 children ages 2 – 10 diagnosed with mental retardation and autism. (TANF $$)

11. 2007 Session • The final 20 remaining institutional beds at Sierra Regional Center were eliminated in the budget – community crisis prevention/intervention teams authorized. • AB 629 passed creating Nevada Autism Task Force and appropriated $2M in general funds for Autism Services

12. 2009 Session • Legislature approved recommendation to consolidate the Office of Disability Services (in DHHS Director’s Office) with Division of Aging Services – Division of Aging Services became Aging and Disability Services Division • Developmental Disabilities, Community Based Services, and IDEA Part C Office were transferred. • Senior Rx and Disability Rx were transferred from Healthy Nevada Fund to their own budget account in ADSD • Legislature approves additional $3.2 M for autism services (above the $2M approved in 2007 session)

13. 2011 Session • Developmental Disabilities Council/budget account moved back to DHHS Director’s Office from ADSD – autonomy issue • Senior Citizen’s Property Tax Assistance program was eliminated saving approximately $6M each year. • Senior Medicare Patrol program was transferred from the Attorney General’s office to ADSD • AB 345 passed establishing Autism Treatment Assistance Program (ATAP) as primary treatment program – funds transferred from MHDS self-directed autism program

14. 2011 Session (continued) • EPS services addressed by Legislature as a result of Clark County transferring EPS function to the State effective May 2010 – 15 new staff approved. • Received Medicaid Money Follows the Person (MFP) Grant April 1, 2011 (runs thru 2016)

15. 2013 Session • Alzheimer’s Task Force created (AB 80); and Respite Care Program expanded (SB 86) for person’s with Alzheimer’s or dementia. • Nevada Early Intervention Services (NEIS) transferred from Health Division to ADSD. IDEA Part C Office transferred to DHHS Director’s Office oversight. • ATAP gets $11.7M biennium budget (GF and Tobacco $$) • FY 14 slots = 307 • FY 15 slots = 572 • Regional Center budgets (3) and Family Preservation Program budget are transferred from MHDS to ADSD • DRC receives 52 new staff to support caseload growth and individuals requiring intensive behavioral support -- $24.4M added to budget

18. Waivers FY14/15

19. Autism Funding Autism Treatment Assistance Program (ATAP) within Aging and Disability Services is the only program that has received funding specifically for autism services.*FY11 pilot program with one-shot funding

20. Integration – What is Next? • Strategic Planning – develop next 5 – 10 year plan • Performance – Outcomes – Accountability • Develop Information Systems – collection of meaningful data • Make sure unique stakeholders are not lost in the process • Look for new funding sources/opportunities – Grants! • Combine Waivers (HCBW –AL- WIN) • Understand the new health care system – The ACA • Apply for/implement CMS Balancing Incentive Payment Program (BIPP)