White Paper on New Waiver For Persons with Developmental Disabilities

[Guest guest]

This is long but worth taking a look at...

It is quite promising!

Ellen

The Arc of Illinois

March 16, 2009

Leaders in The Arc:

Here is the Draft White Paper the Division of Developmental Disabilities has put

together with the Ad Hoc Waive Committee. I think it reads pretty good!

This will be the major focus of our committee tomorrow.

Tony auski

Executive Director

The Arc of Illinois

815-464-1832

White Paper on New Waiver for Persons with Developmental Disabilities

Background

In 2007 the Division received five-year approval from the Centers for Medicare

and Medicaid Services (CMMS) on a renewal for the Adult DD waiver for people

with developmental disabilities. It also received initial, three-year approvals

for two children's waivers. These approvals ensure that federal matching funds

for DD waiver services are secure for the next several years. With these

approvals in hand and no looming deadline, the Division has the opportunity to

expand discussions on the vision for the service delivery system and to draft a

new waiver that supports that vision.

The Adult DD Waiver for Illinois has undergone little substantive change since

the 1990s. While the home and community-based service model in Illinois has

remained consistent over these years, a number of innovations and systemic

improvements have been achieved in other states, and encouraged by CMMS, that

could benefit people with developmental disabilities in Illinois.

The Division continues to work with the Waiver Ad Hoc Committee on new waiver

development. The Division plans to submit the new Waiver request to CMMS for

approval by July 2010.

New Waiver Program Design

Initially, the new Waiver will be limited to a small number of individuals, 500

or fewer. A waiver of state-wideness may be requested initially with the

intention of expanding the Waiver program statewide when total capacity is

increased. This will occur as experience is gained with new services, provider

requirements, quality assurance processes, self-directed service options, and

individualized budget features of the new waiver.

The Waiver Ad-Hoc Committee has identified the following principles for

development of the new waiver:

Flexibility

Individualize supports

Recognize and meet needs of individuals with concurrent conditions, MI/DD,

SA/DD, medical conditions

Close current gap in services between the HBS monthly budget and residential

services

Roll over unused funding from month to month

Cover additional services and supports

Control of Services and Money

Recognize differences between needs of the individual and needs of the family.

Choice

Viable, sustainable capacity of the system

Consider microboards

Independence

Services should not dictate the person's life

Acceptance of appropriate risk

Real Jobs

Change the Developmental Training model

Independent Advocate - to ask for assistance, support and information

Access to Community Resources

Affordable, accessible housing

Transportation

Medicaid State Plan Services

School-funded services for children

Personal Relationships

Address social isolation

Develop circles of support

Accountability and Oversight

Eligibility for services - based on needs, not on cognitive level

As the Waiver Ad Hoc Committee makes recommendations about the new waiver, it

will also identify those changes that may be appropriate to make, through an

amendment, to the current waivers. In this way, the current waiver program will

be modified and improved while the new waiver program is fully developed.

Assessment Tools and Processes

Several committees of the Statewide Advisory Council have each independently

identified the need for the Division to review and consider new and different

assessment tools. As the Waiver Ad Hoc Committee moves forward with its work,

it is expected that recommendations about assessment tools, and their roles at

various points in the process, will be addressed by this and other committees.

The Division will work to ensure there is a coordinated approach to this issue

among committees.

Case Management

A new independent and comprehensive case management approach will be considered

for this Waiver. Comprehensive case management should be provided by an

independent entity that does not also provide any type of direct service. Each

participant will have his or her own case manager selected by the recipient.

The case manager's role will be focused on advocacy for the individual. A

variety of case management responsibilities, currently vested in a number of

positions throughout the system, will be reviewed and may be consolidated. In

this way, case management will form the foundation of a strengthened quality

assurance framework that is in line with the Division's overall goals for

improved quality management across the system. The Waiver Ad Hoc Committee may

also consider whether or not the case management entity should also be charged

with some fiduciary responsibilities for the clients receiving services.

Person-Centered Support Plan

A Person-Centered Support Plan will provide the basis to identify personal goals

and objectives for each waiver participant. Services will be provided to meet

the needs of each recipient and assist them with meeting their goals. Goals,

developed by the individual and their support team, should assist the individual

in achieving long-term objectives identified in a Person-Centered Planning

process.

Individualized Budgets

The Division remains committed to reviewing and appropriately adopting an

individual budget model (or Individual Support Option) for this waiver. The

work done on this in previous years will guide current discussions and program

development. In very basic terms, an individual who uses this option would have

a budget divided into specific sections that may include housing costs,

vocational or employment-related costs, transportation, supports and services,

and one-time needs (funded separately - examples include adaptive equipment and

minor home modifications similar to the current waiver).

Deducted from the total room and board cost would be the individual's Social

Security and any other income. The balance of service costs would be authorized

for payment. The program portion (minus room and board costs) would be eligible

for Waiver claiming.

In order to effectively implement an individual budget model, a new rate

structure will need to be developed. Models in other states and accepted

promising practices for funding individual budgets will be explored in detail.

Efforts will be made to ensure the new funding methodology is based more

directly on the specific needs of the individual, goals identified in their

Support Plan, and tied to key factors that drive service costs. Breaking room

and board costs out separately from service rates will be explored so that the

individual served may have more flexibility in choosing where and with whom they

live.

Living Expenses

For individuals either living alone or with one or two roommates, the housing

budget may include typical household expenses such as rent, utilities, food,

clothing allowance and other necessary personal living expenses subject to state

limits. Limits for household expenses, such as rent, may take into account the

number of individuals living in the household and the median cost in the

specific geographic area where the individual(s) plans to live. A standard

personal spending allowance may be developed for determining independent living

budgets. As part of this process, we will evaluate if or to what extent to

subside personal living expenses. One-time funding for start-up expenses will

likely be included to support the transition of people to community settings.

Meaningful Daytime Activities

Efforts to place participants into appropriate employment will be encouraged

through a choice of vocational services and supports. A primary emphasis will

be on Supported Employment (SEP) and competitive employment. The Division will

work to involve and partner with the Division of Rehabilitative Services (DRS)

to maximize SEP funding from both sources.

Other day or vocational options may include development of day programs for

older people with developmental disabilities, customized employment and

educational supports not funded through other programs.

The new waiver will encourage and support all individuals as they design their

own meaningful vocational and day program activities. These activities may

include work, volunteer experiences, community integration activities (including

some recreational activities) and other activities appropriate for the

participants' age, interests and personal goals.

Transportation

The Division will work with the Waiver Ad Hoc Committee and make every effort to

develop a model that addresses the transportation needs of participants. One

option to address this issue may be to include a specific funding mechanism for

transportation as a stand-alone service. The funding mechanism would need to

address a wide variety of transportation options and would clearly depend on

where the individual lives and the types of transportation available in that

area.

Supports and Services

The sole purpose of the supports and services offered through this waiver will

be to meet the needs of participants and assist them with meeting their personal

goals and objectives. Direct personal support services will be developed to

support activities of daily living such as personal budgeting, meal planning and

preparation, household chores and community involvement. They will also be key

in assisting the individual in making progress on their personal goals.

Community integration activities will be part of the overall budget and may

include recreation and leisure activities. Innovative services covered by

waivers in other states will be explored to identify new services to meet the

needs of those served on the waiver. This will also include services that may

more effectively meet the needs of individuals with behavioral challenges and

medical needs in community-based settings. This is especially important as we

continue with transition efforts at State-Operated Developmental Centers.

In order to more effectively meet the needs of people with developmental

disabilities, the services and supports offered through this waiver will need to

be flexible. Services must be designed to meet increased needs, when necessary,

for those living independently, with family, or in smaller settings. Without

this type of flexibility, people may be unnecessarily moved into 24-hour

settings because capped service levels are not enough. This is not good for the

individuals, their families or the State.

The waiver may provide an opportunity for the Division to establish and support

residential services in smaller settings. Illinois continues to lag behind

other states in serving individuals in smaller (6 or fewer) community-based

settings. Development of a new waiver, and new funding methodology, present a

unique opportunity to systemically address this issue.

Quality Assurance Processes

Development of the new waiver will provide an opportunity to develop and adopt a

quality assurance process focused on the individual and their personal outcomes.

Illinois, like other states, continues to work to improve its quality framework.

Quality standards that focus on service delivery and the needs of the individual

will be of utmost importance as more people are served in family homes and

settings not directly controlled by a provider agency. The Statewide Advisory

Council, Quality Committee continues its efforts in this area. The Waiver Ad

Hoc Committee will work with and rely on this committee as this aspect of the

new waiver is developed.

Please click here to be removed from our list. If you still receive emails from

us in the future, please ensure it was not forwarded from another party or sent

to an email address that is different than the one asked to be removed. DO NOT

REPLY TO THIS EMAIL. Or write us at:

The Arc of Illinois

20901 S. LaGrange Rd. #209

fort, IL 60423