FUNDING SYSTEM RE-DESIGN FOR EMPLOYMENT AND DAY SERVICES Where Are We Now and How Will We Move Forward? 1
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
FUNDING SYSTEM
RE-DESIGN FOR
EMPLOYMENT AND
DAY SERVICES
Where Are We Now and How Will We Move Forward?
1
2
0
50
100
150
200
250
300
350
400
VT
NY IA SD RI
OH
OR
DC
MN
NE
CT
WI
WY
MA
MD
AK
WV IL KS
NH
CA
PA
MT
TX IN MI
CO SC
NM NC
VA
WA LA OK
KY
AZ
AL
TN
UT
MS FL NV
MO
Ind
ivid
ual
s S
erv
ed
Pe
r 10
0K
in P
op
ula
tio
n
Individuals Served in Day Services Per Capita
Source: Butterworth, J., Hall, A.C., Smith, F. A., Migliore, A., Winsor, J., Domin, D., & Sulewski, J. (2013). State Data: The national report on employment services and
outcomes. Boston, MA: University of Massachusetts Boston, Institute for Community Inclusion.
Ohio #6
3
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Wa
shin
gto
nO
kla
ho
ma
Co
nn
ect
icu
tW
est
Vir
gin
iaN
ew
Ham
psh
ire
Mar
ylan
dV
erm
on
tN
ew
Me
xic
oLo
uis
ian
aO
reg
on
So
uth
Car
olin
aM
ain
eM
assa
chu
sett
sA
lask
aC
olo
rad
oU
tah
Oh
ioW
isco
nsi
nIo
wa
Ne
vad
aA
rizo
na
Vir
gin
iaS
ou
th D
ako
taW
yom
ing
Ind
ian
aM
inn
eso
taD
istr
ict
of
Co
lum
bia
Ken
tuck
yN
ort
h C
aro
lina
Ten
ne
sse
eK
ansa
sP
enn
sylv
ania
Ge
org
iaC
alif
orn
iaFl
ori
da
Mo
nta
na
Mis
sou
riN
ew
Je
rsey
Illin
ois
Ala
ba
ma
Tex
asId
aho
Haw
aii
Ark
an
sas
Del
awar
eM
ich
igan
Mis
siss
ipp
iN
ort
h D
ako
taN
eb
rask
aN
ew
Yo
rkR
ho
de
Isla
nd
Individuals in Integrated Employment as a % of Individuals Receiving Day Services 2012
Ohio #17
4
0
50
100
150
200
250M
N SD
OH
WI
IA RI
PA
NY
OR IN SC
OK
MA
MI
NV
LA NC
CA
MS
WV
WY
NE IL CT
AZ
WA
VA
NH AL
AK
CO
DC
GA
MD
MO
NM VT
Ind
ivid
ual
s S
erv
ed
Pe
r 10
0K
in P
op
ula
tio
n
Individuals Served in Sheltered Workshops Per Capita
Source: Butterworth, J., Hall, A.C., Smith, F. A., Migliore, A., Winsor, J., Domin, D., & Sulewski, J. (2013). State Data: T he national report on employment services and outcomes. Boston, MA: University of Massachusetts Boston, Institute for Community Inclusion.
Ohio #3
5
0
20
40
60
80
100
120
140
160
VT WA OR RI OK DC NM AK MN SC WY LA IN KS CA GA MT IL TN NE KY AL
Ind
ivid
ual
s S
erv
ed
Pe
r 10
0K
in P
op
ula
tio
n
Individuals Served in Integrated Employment Per Capita
Source: Butterworth, J., Hall, A.C., Smith, F. A., Migliore, A., Winsor, J., Domin, D., & Sulewski, J. (2013). State Data: The national report on employment services and outcomes. Boston, MA: University of Massachusetts Boston, Institute for Community Inclusion.
Ohio #8
• Three years ago, CMS issued guidance for employment and day services: Informational Bulletin: September 16, 2011
• Updated core service definitions
• Created new services to better reflect best practices
• Emphasized the importance of employment in the lives of people with disabilities
CMS
BULLETIN:
EMPLOYMENT
6
“Work is a fundamental life activity for adults with and without disabilities….it provides a sense of purpose, shaping who we are and how we fit into our community…”
CMS
BULLETIN:
EMPLOYMENT
7
• Emphasized the critical role of person centered planning in achieving employment outcomes
• Clarified that “pre-vocational services are not an end point, but a time limited service for the purpose of helping someone obtain competitive employment.”
CMS
BULLETIN:
EMPLOYMENT
8
• Created a new service definition for career planning that can be used for youth with disabilities, individuals seeking to transition from prevocational services who want a job that is better or more in line with their interests and talents.
• Split supported employment into two services: Individual and Small Group
– Group supported employment is for 2-8 individuals
– Outcome is individualized competitive, integrated employment
CMS
BULLETIN:
EMPLOYMENT
9
• Released January 2014 and took effect March 17. 2014
• Rule was developed over five years with two public comment periods
• Intended to ensure individuals receiving HCBS services under a Medicaid Waiver “have full access to the benefits of community living and the opportunity to receive services in the most integrated setting appropriate.”
• Applies to all settings where HCBS are delivered, not just to residential settings.
HCBS
SETTINGS
RULE
10
• Person-centered planning:
– Not part of the transition plan; already in effect
– Includes individualized goals and preferences related to:
• relationships,
• community participation, employment,
• Income and savings,
• healthcare and wellness, education and others.
HCBS
SETTINGS
RULE
11
• Informed Choice
• Extends beyond simply asking a person if they would like to remain in a segregated setting
• Agencies must take affirmative steps to provide information about the benefits of integrated settings;
• Facilitating visits or other experiences in such settings;
• Offering opportunities to meet with other individuals with disabilities who are living, working and receiving services in integrated settings
• Identify and addresses any concerns or objections
HCBS
SETTINGS
RULE
12
• HCBS must have all of the following qualities:
Is integrated in and supports access to the greater community
Provides opportunities to seek employment and work in competitive integrated settings, engage in community life, and control personal resources
Ensures the individual receives services in the community to the same degree of access as individuals not receiving Medicaid HCBS
HCBS
SETTINGS
RULE
13
• Aligns Medicaid funding with recent Department of Justice actions
• Complements the Integration Mandate of the ADA
HCBS
SETTINGS
RULE
14
What does Integration look like?
• Community-based recreational, wellness, social, educational, cultural, and athletic activities, including community volunteer activities and training activities.
• Volunteering
• Interning
• Taking a class
• Learning about careers and interests
• Promotes interaction with community
• Not a disability-specific program
HCBS
SETTINGS
RULE
15
• DODD has contracted with two policy and systems change experts, Allan I. Bergman and Lisa Mills, PhD to review current funding system for day and employment services
• This process dovetails with the CMS Transition Plan Work for HCBS Settings compliance
FUNDING
RE-ALIGNMENT
PROCESS
16
• Researched multiple states with high performance in integrated employment and day services
• Report can be found at www.ohioemploymentfirst.org
FUNDING
RE-ALIGNMENT
PROCESS
17
• Twelve Community forum meetings held to seek input and feedback
• More than 700 stakeholders attended
• Feedback shaped the Guiding Principles for Funding System Re-design
FUNDING
RE-ALIGNMENT
PROCESS
18
• Laura Zureich, Shelby/Champaign DD
• John Pekar, Fairfield/Vinton DD
• Jason Umstot, OPRA
• Chris Filler, OCALI
• Pete Moore, OACB
• Dan Ottke, OAAS/Clermont DD
• Greg Dormer, OOD
• Vic Gable, Wood DD/Ohio APSE
• David Reichert, Cuyahoga DD
• Rick Black, Butler DD
• Carmen Shelton, self-advocate
• Mary Vail, Goodwill Columbus
• Steve Koons, Cincinnati Goodwill
• Lori Horvath, Chris Miller, Clay Weidner, Greg Swart, Monty Kerr, Kristen Helling, Debbie Hoffine, DODD
WORKGROUP
PARTICIPANTS
19
• Consider what the Ohio employment/day service array should include
• Develop recommendations for service definitions, provider qualifications and rate methodologies
WORKGROUP
CHARGE
20
• Eight workgroup meetings (October-February)
• 60 workgroup face-to-face hours
• Assignments between meetings
WORKGROUP
TIME LINE
21
Service Definitions and Array
Provider and Staff
Qualifications
Methodology for
Determining Cost Per
Hour of Service
Unit Type: Time
Outcome Combination
Reimbursement Rate
Methodologies
WORKGROUP
APPROACH
22
• Proposed Service Array has been developed;
• Service definitions have been drafted
• Starting to develop provider qualifications and rate methodology
• Expect to file waiver amendment with CMS by September 2015 with changes to take effect in 2016.
WAIVER
CHANGES
23
Current Waiver Services
Activity Voc Hab SE- Enclave SE-Community OOD
Vocational Assessment X X X X
Vocational Profile Development X X X X
On-going Support X X X X
Developing Systematic Plan of Instruction and Support, Task
Analysis
X X X X
Support for integration at worksite X X X X
Transportation Training X X X X
Problem-solving Assistance/Meeting Job Expectations X X X X
Natural support facilitation X X X X
Skill Training (hygiene, work skills, self-determination goals,
social skills, behavior modification)
X X X X
Developing and implementing a plan for transition to
employment
X X X X
Self-medication support or medication admin X X X X
Job development and placement X X X
Resume development X X X
Job seeking skills training X X X
Worksite Analysis , including job customization X X X
Employer outreach and awareness X X X
Job training/coaching X X X
Follow-along/retention X X X
Identifying worksite accommodations X X X
Purchasing or modifying equipment for worksite accessibility X X X
Self-employment support X X
Proposed Waiver Services
25
Activity Informed
Choice
Process
Employment
Navigation
Integrated Skill
Building for
Employment
(prevoc)
SE- Small
Group
SE- Individual
(1:1)
OOD
Conflict-free informed choice X
Coordination of progress on path to
employment and access to services
X X
Skill building before and during job
search
(small group; non-job specific)
X
Skill building post job development
(small group; non-job specific)
X
Skill building before and during job
search (small group; job-specific)
X
Assessment/discovery X X
Employment or self-employment
planning
X X
Job placement X X
Job training/coaching X X
Skill building before and during job
search (1:1; job-specific)
X X
Career Advancement X X
Benefits Planning/Support X X
Place 4:
I don't think I want to work, but
may need to learn more
about it.
Place 3:
I'm not sure if I want to work, but
need help to understand my options.
Place 2:
I want to work! Help
me get a job.
Place 1:
I have a job but need
support to keep it or
get a better job.
Who Am I?
26
Employment Navigation
• 1:1
• Proposed to add to SSA Role as a function of Targeted Case Management (TCM)
• Assures facilitation and coordination of a seamless transition among needed employment services and supports from various systems, including education, VR, workforce development and benefits counseling
I may want to pursue community employment, or I am already pursuing or working in community employment, and I need help to navigate systems and services available to me
27
Place 4:
I don't think I want to work, but
may need to learn more
abou it.
Place 3:
I'm not sure if I want to work, but
need help to understand my options.
Informed Choice Process
• 1:1
• Abridged discovery
• Career exploration
• Informational interviews
• Time-limited
• Approximately 24-28 hours
I am not in community employment and not sure I want to pursue community employment
28
Supported Employment-Individual
• 1:1
• Supported employment assessment
• Discovery process
• Other funding source: OOD
I want to pursue community employment but I need help to identify the type of job(s), task(s), and conditions for employment that I want/need
29
Integrated Skill Building (prevocational)
• 1:2; 1:3; 1:4
• Integrated skill building
• Time-limited
I am seeking community employment and I have a need for immediately available, waiver-funded daytime supports that have a focus on building general skills for community employment
30
Supported Employment-Individual
• 1:1
• Work Incentives Benefits Counseling
• Other funding source: OOD
I want community employment and I have a need for a comprehensive benefits analysis to move forward
31
Supported Employment-Small Group
• 1:2, 1:3, 1:4
• Paid work experience that results in building of job specific skills
I am seeking community employment and I want and have a need for immediately available, waiver-funded daytime supports that involve paid work in regular business or industry setting for job specific skill building
32
Supported Employment-Individual
• 1:1
• Initial job training
• Other funding source: OOD
I just got community employment and my employer and I have a need for training and on-the-job support; or I just got self-employment and I need training and support to maintain the self-employment.
33
Supported Employment-Individual
• 1:1
• Job Advancement
• Other funding source: OOD (possibly)
I have community employment but I want more hours in the same job.
34
Supported Employment-Individual
• 1:1
• Extended Job Training/Coaching
• Other funding source: OOD
I have community employment but my employer and I have a continued need for training and coaching so I can become more independent on the job; or I have self-employment and I have a continued need for training and coaching so I can become more independent in self-employment.
35
Workplace Personal Assistance
• 1:1
• Other funding sources:
– Social Security PCA Program
– OOD
I have community employment and have maximized my ability to be independent on the job but I still have a need for personal assistance or personal care while at work.
36
Integrated Community Supports
• 1:2, 1:3, 1:4
• Wrap-around supports
I want and have a need for waiver-funded daytime supports to help me have an integrated life during the hours I am not working, while I am pursuing CE, or if I have made an informed choice not to pursue CE at this time.
37
• Workgroup meets again later this month and then twice in January and February
• Analyze data from EF Outcome Tracking System to determine how current acuity tool indicates level of support
• Finalize definitions, provider qualifications
• Finalize rate methodologies and explore side-by-side funding pilot options
NEXT STEPS
38
Related Documents
