Life Choices Project (Initiative to Enhance the DD Case Management System) Greg Fenton April 2, 2014

1. Life Choices Project(Initiative to Enhance the DD Case Management System)Greg Fenton April 2, 2014

2. The best way to predict the future is to create it.

3. Case Management Should: Act on behalf of the state to…… • Assess each person’s needs • Create a service plan to meet those needs and offer choice of provider • Assist people in accessing generic community services • Monitor individuals and services to assure health, safety and that needs are met • Assure that what people are buying reflects their true needs and choice and meets basic standard of quality • Assure that federal Medicaid assurances are met: i.e. health and safety

4. Opportunities and Threats • In order to meet Ligas requirements, we must ensure • transition plans describe all services required, how they will be developed and obtained and a timetable for transition established before a provider is chosen. • transition plans are not limited by the current availability of services but are within the confines of the Waiver and State Plan. • a statewide database is maintained in which all class members are enrolled. • In order to meet the CMS HCBS waiver requirements: • entities and/or individual that have responsibility for service plan development should not provide other direct waiver services to the participant. • In order to meet Balancing Incentive requirements: • There should be separation of case management from direct services provision: Structurally or operationally, case managers should not be employees of any organization that provides direct services to the individuals. Ideally, conflict-free case management agencies are stand-alone and provide no other direct services. This prevents financial pressure for case managers to make referrals to their own organization or the “trading” of referrals. • By promoting independent case management and standardizing practices, we can effect an increase in quality service delivery and reduce health and safety risks. • Inconsistency in practice across the state undermines fair treatment and trust in the system .

5. Proposal to Strengthen the Role of Case Management (CM) Seeks to: • Improve and standardize CM functions across all 18 ISC agencies • Eligibility determination • Waiting list management • Service planning • Monitoring and oversight • Realign service planning and choice of provider – CM Complete a service plan with person and family before the provider is chosen – NEW • DD approves funding amount • Person chooses providers

6. How Do We Accomplish the Redesign? The intent of the redesign is to build upon the existing system in a manner which enhances the efficiency and effectiveness of the six key functions within the DD system. These functions include: • Intake and DD eligibility determination • Prioritization of the Urgent Needs for Services (PUNS)/Waiting List management • Waiver Eligibility and Enrollment • Individual Profile Development • Service and Provider Selection • Service Monitoring

7. What is involved? • Eligibility determination process – streamlined and simplified. Eligibility for developmental disability services will be determined directly after intake is complete. • PUNS is being updated through the input received from listening sessions around the state. • Medicaid HCBS Waiver eligibility will be completed within the timeframe of HCBS service initiation. • Profile and Desired Outcomes Plan will be developed with the person, their PAS/ISSA and family members. • People will use their Profile and Desired Outcomes Plan to select service providers. • ISSA will monitor services to assure their delivery is consistent with what is in the person’s Profile and Desired Outcomes Plan. • Providers will continue to write the ISP demonstrating how they will deliver the services they are authorized to deliver.

8. Enhancing the Role of the Service Coordinator The knowledge, skills and competency of the PAS/ISC/ISSA agency staff is crucial in accomplishing this work. Therefore, a specific team identifying enhancements to the roles and responsibilities of Service Coordinators will be convened. The effectiveness of service coordination (SC) relies on three critical components: • The knowledge, skill and ability of each service coordinator individually, and of the agencies collectively. • The management of the service coordination. • The overall design of the system, including the role and authority assigned to service coordination.

9. Benefits of Improving Case Management Standardize practices across the state to achieve consistency Assure that services meet people’s true need Empower individuals & families to make choice free of provider influence Improve the oversight/monitoring of services and health and safety Align with the Governor’s Restructuring Plan Comply with the Balancing Initiative requirements and the capacity to earn increased FFP Comply with Ligas Settlement Agreement Comply with CMS Medicaid 1915 (c) requirements

10. What is the desired outcome of this initiative? For all individuals with intellectual disabilities in Illinois to: • be healthy and safe • have real relationships with family and friends • have a paying job if they want to work • make decisions about their lives • have opportunities to contribute to their community

11. Proposed Changes to Support Rebalancing Efforts Full Level IIs are not required for individuals moving from SODCs and private ICFs/DD to Waiver services Updated psychological evaluations are no longer required for individuals with severe/profound intellectual disabilities  Physicals within one year, rather than 30 days Currently reviewing the PAS Manual to change all references to MR

12. Next Important Steps • Work teams are meeting to develop the details of how each new process will occur. • Teams will accomplish established objectives. • Resources and funding support will be identified to implement action plans. • Policy changes will be communicated to all stakeholders and meeting minutes will be posted on the DHS Website. • Policy manuals will be revised to reflect changes. • All ISSAs will receive training on the new process.

13. Swiss Watch Story – In 1968, the Swiss dominated the watch industry. They had 65% of the world’s market share and more than 80% of its profits,. They were, however, skeptical of new technology, such as the Quartz technology – which produced watches that were electronic, battery operated, and far more accurate than traditional mechanical watches. As a result, within 10 years, the Swiss watchmaker’s market share fell to below 10%.