NASDDDS Board of Directors Meeting · 2018. 1. 31. · (35%) by the AIDD Supporting Families grants. Those grants end in 2016, 2017 respectively. The association staff is requesting

NASDDDS

Board of Directors Meeting

Tuesday, March 17, 2015

3:00 PM – 5:00 PM

Eastern Daylight Time

NASDDDS Board of Directors Meeting

Wednesday, March 17, 2015 3:00 PM – 5:00 PM

512-225-3050 Guest Code 716254#

AGENDA

I. Approval of Minutes from the Board of Directors November 11, 2014 Meeting ........................................ ACTION....................3

II. Program Operations Report .................................... Information..................10

III. Year-to-Date Financial Report / March 2015 .......... Information..................21

IV. Personnel Benefit Change ........................................... ACTION .................25Reimbursement for Health Insurance Health Advocate Benefit

V. Fiscal Year 2015-2016 Dues Increase ......................... ACTION..................70

VI. Statement on The Rights of People with Cognitive Disabilities toTechnology and Information Access ............................. ACTION.................73

VII. Board Calls to State Directors .................................. Discussion..................77

VIII. 2015 Mid-Year Conference Program ...................... Information..................97

IX. 2015 Compass Award .................................................. ACTION................101

X. New Business .............................................................................................103

XI. Executive Session ......................................................................................104

Board of Directors Responsibilities & Schedule FEB/MAR

Reviewing the annual IRS Form 990 Review results from calls to directors Board performance review

MAY/JUN

Review and approve annual budget Review performance of executive director

Third Friday in February: Evaluation forms distributed to board members; self-evaluation form transmitted to the executive director.

Third Friday in March: Evaluation/self-evaluation forms submitted to board president.

Third Friday in April: Evaluation results tabulated and share with executive director and all board members.

May mid-year meeting: Board/executive director meet to discuss evaluation findings and identify improvement strategies.

JUL/AUG

Submit annual conflict of interest disclosure statement

NOV Meeting with auditors to review agency audit - fall Meeting with financial advisor to review investment performance

DEC – FEB Board calls to state directors

Secretary/Treasurer Responsibilities

Review audit proposals Review draft audit with auditors Sign documents as needed Review executive director's credit card bills and travel expenses -

quarterly

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AGENDA ITEM I ACTION Approval of Minutes from the Board of Directors November 11, 2014 Meeting PRESENTER Bernie Simons

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NASDDDS Board of Directors Meeting

November 11, 2014 The Westin Alexandria Hotel ~ Alexandria, Virginia

Participating Board Members Jane Gallivan (Delaware), President Laura Nuss (District of Columbia), Vice President / President Elect Bernie Simons (Maryland), Secretary/Treasurer John Martin (Ohio), Member-at-Large Beverly Buscemi (South Carolina), Member-at-Large Alex Bartolic (Minnesota), Member-at-Large Courtney Tarver (Alabama), Member-at-Large Guest State Directors Dan Lusk, South Dakota Terry Macy, Connecticut Participating Staff Nancy Thaler, Executive Director Robin Cooper, Director of Technical Assistance katherine karol snyder, Director of Administrative Services Barbara Brent, Director of State Policy Mary Lee Fay, Director of National Core Indicators Dan Berland, Director of Federal Policy Rie Kennedy-Lizotte, Director of SELN Jeanine Zlockie, SELN Program Specialist Megan Rose, Office Manager Nicole Orellana, Office Associate ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The board meeting was called to order at 9:00 AM by president Jane Gallivan who then asked that each person at the meeting introduce themselves. APPROVAL OF MINUTES FROM THE JUNE 25, 2014 BOARD MEETING Jane Gallivan then asked to proceed with approval of minutes. Alex Bartolic questioned a budget number on page seven. Nancy Thaler said they would research/review and report back. Without further questions or discussion, Beverly Buscemi motioned to adopt the minutes pending clarification. Bernie Simons seconded. The motion was then approved by all. PROGRAM OPERATIONS REPORT Nancy Thaler with the assistance of involved association staff reported on the following:

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New Office Space Office space transition is underway. The furniture is scheduled for installation the week of November 12th and the staff scheduled to move in the week of the 24th.

New Directors

Steve Suroviec Pennsylvania Lilia Teninty Oregon Novelene Martin Montana Valerie Huhn Missouri Dan Howell Georgia as permanent director David Fray Hawaii has retired and Jeff Okamoto is acting

Gary Smith Scholarship Kai-Stefan Fountain, Psychological Assistant with the Delaware Division of Developmental Disabilities Services was the recipient of the Gary Smith Scholarship to the Leadership Institute in July 2014.

New Projects

o Balancing Incentive Program Evaluation In partnership with RTI and NASHP, NASDDDS is to assist in the effort to gauge the efficacy of the BIP program. NASDDDS will provide technical expertise related to the impact on services and infrastructure for individuals with I/DD. Mary Sowers is the point of contact on this work.

o Colorado Regional Center Review Project Working with HMA, NASDDDS is to provide technical expertise related to other states' strategies to reduce or eliminate institutional reliance. NASDDDS will provide important perspectives on strong system attributes that contribute to success for community living for all individuals regardless of their support needs. Shane Spotts (former state director) was working on the HMA side. Barbara Brent and Mary Sowers are supporting the effort.

o Miscellaneous Technical Assistance Engagements Official engagement has occurred Magellan but has been terminated for now as they decided that there is no work in this managed care area on the horizon for now. McKinsey has been connected with Mary Lou Bourne regarding person-centered planning.

Current Grant Projects o AIDD Community of Practice Supporting Families of Person with I/DD

Five-year project o AIDD NCI Data Management Project

Five-year project to increase state participation

Technical Assistance Projects o Maryland and Delaware Since two board members have TA going on in their

states, Nancy asked for their input

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Maryland Bernie Simons reported on the NASDDDS staff assistance on waivers; staff TA included Mary Sowers, Jeanine Zlockie, and Mary Lee Fay on a separate consult.

Delaware Jane Gallivan reported that she also had assistance from NASDDDS staff. Mary Lee Fay's work focused on family support waiver.

o Louisiana NASDDDS is providing technical advice related to I/DD-specific considerations for the development of a managed long term services and supports program. Barbara Brent, Robin Cooper, and Mary Sowers are supporting the state in this effort. The contract was extended an additional quarter to continue assistance to Louisiana.

o Federal Policy Nancy Thaler suggested that since the Wednesday Directors Forum would be focused on federal policy that she would give a brief summary which highlighted the CMS HCBS Rule.

o National Core Indicators Mary Lee Fay indicated that NCI will revise family survey to better reflect family experience. Nancy Thaler and Mary Lee Fay also reported on the decision with HSRI to put the agreed to surplus from both organizations toward the NCI validity surveys and that the NCI staff stability tool has been revised to better reflect the status of direct support professionals hired by agencies.

o SELN Rie Kennedy-Lizotte gave a brief overview of SELN projects, etc. reporting that the 2014-2015 membership year started with 28 member states. Minnesota will become the 29th member state on January 1, 2015, for the current fiscal year. A very successful ninth annual meeting was held in Alexandria, Virginia, October 20-22, 2014 with 27 participating states teams.

o AIDD Grant Community of Practice Mary Lee Fay reported that the eight states participating in this project continue to focus on strengthening working relationships with state partners, especially among education, vocational rehabilitation, and the DD operating agency with the focus on supporting youth and young adults exiting high school to be prepared and engaged in working in integrated community jobs.

YEAR END FINANCIAL REPORT Nancy Thaler reported that the auditors will be meeting with the board later in the day and have previously discussed the audit with Bernie Simons as Secretary/Treasurer. Revenue from grants is the biggest deviation based on the fact that money from

work not yet accomplished is moved forward. The bonuses that staff received by FY 2012-2013 and the payout for Chas Moseley

leave buyout at his departure in March 2014 are an expenditures to last fiscal year's budget.

Five Year Fiscal Performance show how the association's finances continue in a stable, positive director.

Trust Fund Reserve Status remains stable. Moving and Furniture Expenses for the new office location were explained by

Nancy Thaler.

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National Core Indicators Investment Nancy Thaler reported that the National Core Indicators FY 2013-2014 year (membership fees combined with the AIDD grant) resulted in a $76,363 revenue excess. The excess reflects a decision to factor in a small percentage on the contract with HSRI (5%) nor all of the direct time of the executive director. The excess is enhanced by the AIDD grant which covers $25,000 in salaries and benefits. The project director's time and salary is also being shared (35%) by the AIDD Supporting Families grants. Those grants end in 2016, 2017 respectively.

The association staff is requesting approval to invest the NCI surplus into the validity study of the NASDDDS tool. President Gallivan asked for questions and then a motion to approve the investment. Alex Bartolic moved to approve the expenditure. Beverly Buscemi seconded and the approval to commit $50,000 to invest in NCI research regarding validity and reliability was unanimous.

RESEARCH COMMITTEE REPORT Mary Lee Fay asked that Barb Brent present the two items that the research committee is seeking approval on Definition of Positive Behavior Support and Definition of Aversive Interventions. The point of taking a position is to state that the association believes in and supports the definitions. Definition of Positive Behavior Support The suggestion was made by Nancy Thaler that the first paragraph be dropped and the wording changed at the beginning of the definition of Positive Behavior Support to: "The key features of PBS are:"

and at the bottom the key features source is listed and linked. Bernie Simons moved that the definition be approved with the changes as outlined above; Laura Nuss seconded. The motion was approved by all. Definition of Aversive Interventions Barb Brent reviewed the process behind the development of the definition of aversive interventions. The discussion concluded that the definition once approved would not be approved until the position state be adopted and that the last paragraph be rewritten so that it can be more easily understood by a general audience and that the phrase "positive behavior supports" be included; and once done, the definition will be brought back to the board for approval after lunch. NOMINATIONS OF BOARD CANDIDATES Nancy Thaler explained the succession of the board members. Ms. Gallivan asked for discussion; there was none. Beverly Buscemi moved that the slate of officers and members-at-large be adopted. Alex Bartolic seconded and the nominations were approved by all. BOARD CALLS TO STATE DIRECTORS

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Nancy Thaler suggested that the calls to state directors be moved to be included in the succession planning discussion during the executive session. President Gallivan agreed. CONFERENCE SCHEDULE Nancy Thaler reviewed the schedule for the conference for the remainder of the week. FY 2013-2014 AUDIT REPORT Ms. Thaler introduced Jackie Oneto, Partner, Gelman, Rosenberg & Freedman, CPAs who reviewed the audit report. Ms. Oneto explained that an A-133 audit was required based on government revenue received during the fiscal year. Of note:

The association has been presented a clean opinion (page I-3) net assets are unrestricted which is preferred (page I-5) net assets increased over the previous fiscal year (page I-6) supporting services are well under 25% which is the max preferred (page I-6) investments listed at fair market value and are level one low risk investments

(page I-14) no outstanding balance on end of year line of credit (page I-16) supplemental information required by A-133 audit lists all federal grants and

revenue (page I-17) with everything that was reported there were no reportable findings – result was

a clean A-133 audit report (page II-1) furniture left behind and no longer in use will have $0 value… new furniture

purchased to be document for value and depreciated until no longer in use. Ms. Gallivan asked for a motion to accept the audit. Courtney Tarver moved to accept the audit as presented, Laura Nuss seconded and the motion was approved by all. PNC FIDUCIARY TRUST REPORT The fiduciary trust report was reviewed by Phillip Brown, Vice President, Senior Portfolio Manager PNC Institutional Investments who explained their philosophy regarding the association trust investments. After discussing the fact that there is a note on the trust account that maintains $50,000 cash, the recommendation was made by Ms. Gallivan and Ms. Thaler was to approve that it is only necessary to keep 1 percent of the trust as cash and authorization was given to Mr. Brown to make that change on November 12, 2014. Mr. Brown continued with the report by discussing the stability of the market and that the association accounts are in index funds and continue to produce. Other item of note is that based on the S&P 500, C rated stocks are outperforming A and B rated stocks.

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50 YEARS OF HISTORY BY BOB GETTINGS Nancy Thaler stated that the history was included to bring the board's attention to how the association has evolved and lessons learned may be used during the executive session regarding the succession planning. REVISED DEFINITION OF AVERSIVE INTERVENTIONS Mary Lee Fay explained the change in language to the definition as recommended in the earlier session. Laura Nuss noted that the word positive was omitted preceding behavior. Nancy Thaler added that the wording in the policy statement remains unclear and that it needs to be hand in hand with the policy statement. It was then requested that the policy statement be crafted before the next board meeting. Jane Gallivan asked for a motion to accept the revised definition as presented by Mary Lee Fay. Alex Bartolic moved to accept; Laura Nuss seconded. The motion was approved by all. NEW BUSINESS Bernie Simons reviewed the evolution of the community of practice and discussed whether or not the association should explore the project given that the grant money will be ending in the next year or so. Mary Lee Fay stated that the association will need to determine the actual costs and to evaluate the state of the project and what is actually needed. Nancy Thaler added that the association needs to look at how the program can continue after the grant ends and that one possibility is for the association to fund staff oversight or provide funding from the excess in the fiduciary trust account to reinvest in the members. Jane Gallivan recommended further discussion at a future board meeting. The board meeting adjourned into executive session at 3:25 PM. Respectfully submitted, Bernie Simons Secretary/Treasurer

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AGENDA ITEM II INFORMATION Program Operations Report Presenter: Nancy Thaler NASDDDS ADMINISTRATIVE New Office Space Successfully moved into new office space. The 113 Oronoco Street property is on the rental market. While a number of people have looked at the space, there are no renters at this time. DIRECTOR CHANGES and Director Longevity RHODE ISLAND Maria Montanaro appointed director February 2, 1015 CONNECTICUT Morna A. Murray, J.D. appointed Director February 13, 2015 ILLINOIS Greg Fenton appointed acting director effective March 15, 2015 2014 Chart of Director Turnover 48% of state directors are in their positions for two years or less. 78% of state directors are in their positions for three years or less. Years in position 10 9 8 7 6 5 4 3 2 1 <1 % of Directors serving by years 2% 0% 0% 6% 2% 8% 8% 20% 10% 24% 20%

GARY SMITH SCHOLARSHIP FOR THE LEADERSHIP INSTITUTE There will be another scholarship opportunity for the Summer Leadership Institute in 2015. NEW PROJECTS

Miscellaneous Technical Assistance Engagements A number of private entities,

both managed care and consulting firms, have reached out for limited engagements to educate staff and leadership on issues related to I/DD systems. These are intermittent engagements. NASDDDS is scheduled to conduct training with Anthem in April.

CURRENT GRANT PROJECTS

AIDD Community of Practice Supporting Families of Person with I/DD –

Five-Year Project. In partnership with UMKC and HSRI this grant is in year three, ending in 2017.

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AIDD NCI Data Management Project – Five-Year Project to Increase State Participation. In partnership with HSRI, this grant is in year four, ending in 2016.

Balancing Incentive Program Evaluation In partnership with RTI and NASHP,

NASDDDS will assist in the effort to gauge the efficacy of the BIP program. NASDDDS will provide technical expertise related to the impact on services and infrastructure for individuals with I/DD. Mary Sowers is the point of contact on this work.

CURRENT TECHNICAL ASSISTANCE PROJECTS Arizona DD Council – NASDDDS has provided a paper related to Supporting

Families, 1915(i), the history and lessons of Arizona's Medicaid HCBS program for individuals with I/DD, and national trends and considerations related to non-work day services. This relationship will continue into 2015, with additional paper topics yet to be determined.

Delaware (extended from 2013-2014) – Develop policies, billing model, and

organizational designs to convert current state Administrative Case Management to TCM and add a new TCM service focused on individuals living with families or others, not in licensed or certified settings. Develop policies and billing models for state staff TCM model for individuals living in licensed and certified settings. Preliminary drafts of SPAs for both TCM groups have been submitted to Delaware.

Louisiana – NASDDDS is providing technical advice related to I/DD-specific

considerations for the development of a managed long term services and supports program. Barbara Brent, Robin Cooper, and Mary Sowers are supporting the state in this effort. While the contract was extended, there has been limited NASDDDS activity in 2015.

Maryland – Maryland engaged NASDDDS on three projects: one assisting them to

do a review of and provide recommendations on their HCBS waiver, a second focused on their support coordination system, and the third is to assist the state in developing a strategy of supporting families. Staff involved include Nancy Thaler, Robin Cooper, Mary Sowers, and Jeanine Zlockie for the first two projects, and Mary Lee Fay for the Supporting Families work. NASDDDS has delivered a final report on the waiver and is finalizing the report on case management. Ongoing support will be provided to assist the state in prioritizing and staging areas for change.

UMass / AIDD Funded – Community of Practice for Supporting Competitive Employment. Participating states are: Maryland, New Hampshire, North Dakota, Minnesota, Idaho, and the District of Columbia. Staff involved include Rie Kennedy-Lizotte.

UMass / AIDD Funded – Partnerships in Employment. October 1, 2014, was the beginning of year four of this five year system change project. This grant project focuses on cross system change (education, vocational rehabilitation and long term

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developmental disability state agencies) to assist youth and young adults exiting high school to be prepared and ready to enter the general workforce. Participating States are: Wisconsin, Alaska, Iowa, Missouri, Tennessee, North Carolina, Mississippi, New York, and California. Staff involved are Barbara Brent and Rie Kennedy-Lizotte.

EconSys – NASDDDS is a contractor, as subject matter experts, through EconSys

for ODEP. Barbara Brent is the primary staff working on this project as part of the Employment First Leadership Mentor Program.

UMass – Florida employment first consultation. Rie Kennedy-Lizotte is primary staff

working on this project. CMS/New Editions – Consultation on HCBS; 1915(i) and (k). In addition to Robin

Cooper, Barbara Brent and Mary Sowers have joined this project. Illinois Council on Developmental Disabilities – Three contracts to improve case

management, review the waiver and inform families of people living in private ICFs/MR of their options under the Ligas settlement agreement. Ten work groups have made recommendations for the redesign of case management functions which are waiting for the Division's approval. Even though the DD director has resigned, the acting director is very likely to keep up momentum. The new administration has shown considerable interest in the project.

HSRI/Virginia – Systems Reform Contract extension for continued work on waiver

redesign, including review of current waiver services, funding structures, etc. Staff involved are Robin Cooper and Rie Kennedy-Lizotte.

New Jersey – Consultation required by the waiting list settlement agreement continues. The state has asked for assistance in recruiting provider agencies from other states and research on policies about guardianship.

Georgia – Improvement to quality improvement system: improvement to case management services. This has been expanded to include a HCBS waiver review by Robin Cooper. This project continues to have relevance due to Georgia's inability to meet DOJ compliance requirements.

University of Minnesota – RISP/FISP data projects. Data collection has concluded for 2013 and is almost complete for 2014. NASDDDS is working with the University of Minnesota to achieve predictable scheduling of report publication and to ensure that the data is usable and used by our state members. A RISP/FISP data byte has been added to Community Services Reporter and will continue each month.

NASDDDS is continuing efforts to review NCI reports and data analysis, and coordinates research committee and staff to review NCI tool improvements. North Carolina DD Council funded NASDDDS a contract for ($160,000), to continue and expand support for a cross disability stakeholder engagement group that began

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under the first year contract and to provide additional consultation to the Department of Health and Human Services Division of Mental Health, Developmental Disabilities, and Substance Abuse Services. Consultation to the Department has centered on the new HCBS rules and guidance, stakeholder engagement, and managed care. The Stakeholder Engagement Group meets regularly and assisted in the facilitation of statewide stakeholder feedback for the state's transition plan.

Projects Concluded During Prior Quarter

Colorado Regional Center Review Project Working with HMA, NASDDDS

provided technical expertise related to other states' strategies to reduce or eliminate institutional reliance. NASDDDS will provide important perspectives on strong system attributes that contribute to success for community living for all individuals regardless of their support needs. Barbara Brent and Mary Sowers supported the effort. NOTE: This contract concluded in January 2015. The official report from HMA to the State of Colorado has not yet been released publicly.

National Council on Disabilities – Contract for the preparation of an evidence-

based policy report summarizing the research on outcomes associated with home and community-based services. NASDDDS submitted a draft paper for review in May 2014, with a subsequent draft submitted September 26, 2014. The paper has been expanded to include grey literature and policy considerations in addition to available research. The final paper will be submitted to NCD on November 10, 2014. The final paper was published on February 24, 2015.

FEDERAL POLICY There have been numerous contacts and meetings with federal officials in both the Department of Labor and the Center for Medicare & Medicaid Services (CMS) regarding the Home Care Rule (DOL) and the HCBS Rule (CMS). These have included private meetings and calls as well as meetings involving other associations and Webinars. FEDERAL REGULATIONS Companionship Rule The association has been very active in engaging the Department of Labor (DOL) around the Companionship Exemption Rule. DOL engaged the association to discuss its response to the recent court decision

overturning the DOL rule. We and our sister organizations arranged an all-state call for DOL to connect with our member agencies to share their interpretation of the court ruling.

We arranged a meeting between DOJ and HHS/OCR and the state associations to respond to a joint DOJ/OCR letter regarding compliance with the DOL rule and the need for exceptions processes.

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http://www.ncd.gov/newsroom/02242015

CMS Guidance on the Definition of Community The other focus of national policy activity for NASDDDS has been the CMS-issued HCBS rule.

We have participated, with the other state associations, in regular meetings with CMS to discuss implementation of the rule and raise policy issues. To date, these calls have been primarily focused on issues around transition plans.

After Barb Edwards' appearance at NASDDDS annual conference last November, NASDDDS sent a letter to Barb raising several important issues regarding the HCBS rule and asking for a meeting, followed by a second letter to Ralph Lollar raising additional issues and requesting a written response.

A meeting between the NASDDDS board of directors and staff to discuss the issues in our letters was held on February.

The grandfathering discussion was the most significant part of the meeting. CMS will not accept grandfathering because to them that means including services that do not meet the rule. But what a state could do is make enough changes to a noncompliant service to make it compliant with the regulations (the federal floor), and freeze that service. States can create a second description of the service, compliant with a higher state standard that the state would employ in the future.

CMS made clear that the state's decision on whether to ask for heighted scrutiny rests with the states and reiterated this point on the CMS conference call on the regulations on February 6.

After the meeting we said that we'd send draft language on the specific issues of: 1) time frames and 2) an approach to raising program standards beyond the minimal compliance while retaining programs that currently meet the standards minimally. We have done so and CMS has shared the language with our sister organizations, who expressed support.

There have been a number of other communications with CMS, raising questions about issues such as the contractor site visit in North Dakota, and the inclusion of questions regarding compliance with the DOL rule in the waiver approval process.

National Quality Forum HCBS Panel NASDDDS developed a list of nominees for the panel, and marshaled support for their appointment. Several of our nominees, including Gerry Morrissey and Ari Ne'eman, were selected. Pace-Like Demonstration NASDDDS staff have participated in several meetings organized by PACE stakeholders to discuss the possibility of a CMS-funded demonstration project to create a "PACE-

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like" program for individuals under 55 with disabilities or behavioral health needs. We have expressed reservations about the congregate nature of the program. ABLE Act Implementation NASDDDS is participating in an ad hoc coalition with a number of other disability groups, marshaled by the National Disability Institute, to work on ABLE Act implementation issues, including informing the treasury-led writing of federal regulations implementing the law. State Operations and Technical Assistance (SOTA) Team NASDDDS staff and several board members met with the SOTA team to start a relationship and make sure they are aware of us and our particular relationship to the Medicaid program. The conversation was very productive and led to specific plans to incorporate NASDDDS members into the information distribution that SOTA does on a regular basis, as well as other discussion of future collaboration. eLTSS The electronic Long-Term Services & Supports (eLTSS) Initiative is the CMS Office of the National Coordinator for Health Information Technology (ONC) effort to identify and harmonize electronic standards to enable the creation, exchange and re-use of interoperable service plans for use by health care and community-based LTSS providers, payers, and the individuals they serve. The new initiative is driven by the requirements of the CMS Testing Experience and Functional Tools (TEFT) in community-based LTSS Planning and Demonstration Grant Program created in the Affordable Care Act. wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29 This effort is intended to develop standards for LTSS individual plans. The development process uses a Wiki-based crowd sourcing approach which allows anyone who signs on as a committed member to contribute and vote. NASDDDS participation has been extensive (weekly calls and "homework") and, with the encouragement of CMS, is taking the lead in trying to influence the development process to align with current state practice. We anticipate a high level meeting with the ONC to address major concerns about the project:

1) No consideration of states as the principal payers of LTSS 2) Little understanding the most states have or are now developing their own e-

record for developing LTSS plans 3) The intrusion of the medical model into the design 4) A slant in the dialogue town services for the aged.

WEBINARS SERIES NASDDDS is completing a plan for a webinar series for the remainder of 2015, being mindful of the number of webinars and teleconferences already provided due to the

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http://www.healthit.gov/policy-researchers-implementers/certification-programs-policy

http://www.healthit.gov/policy-researchers-implementers/certification-programs-policy

http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29

http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29

extensive changes in federal regulations associated with the new HCBS regulations and the DOL companionships rules. NASDDDS, through the Community of Practice in Supporting Families, held a webinar on January 22, 2015. NASDDDS also hosted a webinar related to the online survey for RISP and FISP on January 29, 2015 to update state data staff on data collection status and methodology. NASDDDS is hosting the next Innovations in Supporting Families Webinar on March 26, 2015. Other webinars in the works include Supported Decision Making, Nebraska's innovations in culture change and reducing the use of psychotropic medications, supporting people with I/DD who are hearing impaired/deaf, and Minnesota's new assessment process. NATIONAL CORE INDICATORS Participation: 42 states including the District of Columbia, 21 California regions, and one Ohio county consortium – totaling 63 entities. Survey Distributions. All survey reports for 2013-2014 have been finalized and

published. Each state has their full reports plus a User Friendly report for all surveys (family and Adult consumer survey) completed. The 2013 annual report was completed in November and distributed at the NASDDDS conference.

Survey Tool Updates. Significant revisions are occurring with all of the NCI

surveys. Throughout the years comments from surveyors about phrasing and ease of understanding questions have led to minor language tweaks in the survey. But the NCI team has been looking more closely at the indicators themselves. Some of the change is coming from the new NCI-AD tool and seeing improved questions. In addition, the NCI team met with staff from UMass and UMN to look at how questions might be asked to indicate quality outcomes for people engaged in work and other community life engagement. The edits have been sent to NASDDDS staff, UMN, UMass and UMKC staff for review and now to state NCI coordinators and the Research Committee. It is anticipated that all edits will be completed for the 2015-2016 data cycle.

Staff Stability Tool Update: The NCI staff stability tool has been revised to better

reflect the status of direct support professionals hired by agencies. NCI requested a focus group of seven providers, identified by ANCOR, to review the tool and comment on content and ability to provide data. The survey asks questions relating to volume, stability, compensation and benefits of direct support professionals serving adults 18 years of age and older. The data gathered from this voluntary and anonymous survey will help states, along with other policy makers and advocates, to:

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1. Inform policy and program development regarding direct service workforce (DSW) improvement initiatives

2. Monitor and evaluate the impact of workforce initiatives 3. Compare state workforce outcomes with those of other states 4. Provide context for consumer and family outcomes 5. Build systems to more effectively collect, analyze, and use DSW workforce data

Ohio and Utah used the tool in November for a pilot test. Both states got a response rate of approximately 25 percent. Minor changes were made after provider and state feedback. The two states are keeping the data open so more providers can add to the data. In addition, seven more states will be completing the survey this year (ending June 30, 2015) for a total of nine states using the survey.

Reliability Study NASDDDS and HSRI have discussed the need to conduct reliability studies on certain aspects of NCI. In 2013-2014, HSRI began to look at background questions with Temple University Celia Feinstein, from Pennsylvania responses. That study provided HSRI and NASDDDS information that will help hone in on key background indicators. We have proposed to develop an in depth reliability study on the background questions and at the same time select several key indicators that can be pulled from NCI for reliability study to be used within the NQF framework. NASDDDS has committed $50,000 from unexpended funds during FY 2013-2014 and HSRI has committed $20,000. UMN has submitted a proposal for conducting background reliability studies using three states. The proposal was reviewed by the Research Committee. See attached proposal and time line.

Data Briefs. There has not been a data brief completed since November 2014. NCI team is working on a data brief of rights and it will be completed by April 2015.

Webinars. There have been no topical webinars since November 2014. However, we have completed webinar reviews of the staff stability tool and Adult Consumer Survey refresher trainings.

Training. Onsite refresher trainings are being held in states that have had changes in Contractors that conduct the surveys or if there is significant turnover in the interviewers

Copyright and Trademark. We have moved forward on a joint (NASDDDS and

HSRI) copyright of the NCI surveys and registering the NCI and National Core Indicators as a trademark. NCI was given formal copyright status in July 2014 and is awaiting the trademark logo on NCI. We have started the conversation on registering the NCI-AD trademark with NASUAD and HSRI.

Expansion of NCI to Aging. The NCI-AD Adult Consumer Survey tool was piloted in three states (Ohio, Minnesota, and Georgia) and a second level pilot occurred in Georgia with survey revisions. The final tool will be complete by March 2015. There are 13 states that will be participating in the NCI-AD. All of those states are existing NCI states.

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AIDD GRANT – NCI DATA MANAGEMENT PROJECT 2012-2017

Year Four States October 2014 – September 2015. Vermont and Rhode Island are the two states in the grant year for 2014-2015.

Year Four AIDD budget was amended in January 2015. The amendment removes some funding that would have gone to states and redirects other funds to staff time and travel for NASDDDS and HSRI. During year four, NCI staff will conduct on-site state reviews with states that started in an earlier year and would like additional support and training. NCI staff will also be available to meet with states who are not yet participating.

SELN AND OTHER EMPLOYMENT PROJECTS SELN – SELN membership for 2014-2015 has dropped from 29 states to 28 states. In January Florida discontinued membership due to fiscal cutbacks. SELN continues to host webinar series on Family Engagement and Life Course considerations with the highest multi-state participation of any of SELN webinar series. This past quarter two major issues have surfaced with urgency in SELN member states, redefining service types and funding methodologies. AIDD Grant on Partnerships in Employment Systems Change / Training and Technical Assistance Center – The eight states participating in this project continue to focus on strengthening working relationships with state partners, especially among education, vocational rehabilitation, and the DD operating agency with the focus on supporting youth and young adults exiting high school to be prepared and engaged in working in integrated community jobs. Rie Kennedy-Lizotte and Barbara Brent are primary NASDDDS staff working as part of the technical assistance center project staff. The project has matured and many partnership states are moving into sustainability and extensive policy work. The Florida Developmental Disabilities Council Grant – NASDDDS is in a renewed subcontract agreement with ICI to work with Florida Interagency Team to support their cross system implementation plan to move employment first forward in the state. There is a strong grassroots and self-advocacy support focus that the project team supports. Rie Kennedy-Lizotte is the primary staff supporting this project. AIDD Employment Learning Communities Grant – State's grantees, District of Columbia, Idaho, New Hampshire, Kentucky, Maryland, Minnesota, and North Dakota are engaged in a series of discussions on large and small business partnerships. New discussion series beginning March 25 will focus on the roles and responsibilities of Department of Education, vocational rehabilitation, and developmental disability agencies to address the necessary system changes in response to of the Workforce Innovation and Opportunities Act. Rie Kennedy-Lizotte is primary staff working on this project.

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EconSys – NASDDDS is a contractor, as subject matter experts, through EconSys for ODEP. Barbara Brent is the primary staff working on this project as part of the Employment First Leadership Mentor Program.

AIDD GRANT – COMMUNITY OF PRACTICE: SUPPORTING FAMILIES OF PERSONS WITH I/DD 2013-2018

State Activities. States are meeting frequently with their own state teams and

participate in the CoP monthly calls. States are preparing for the annual meeting in May where each state will present updates on priorities and activities.

Community of Practice (CoP) calls. The CoP state teams are participating in monthly calls.

Administrative Supplemental to the CoP grant. AIDD added $62,000 to the CoP grant to develop materials focused on family-centered/person-centered plans for youth transitioning from school to work. NASDDDS and UMKC met with family consultants (Dumas, Smith and Bracken) with Support Development Associates (Smull et al) in January to identify strategies in current PCP practices and Life Course practices that focus on supporting families. These materials will be piloted in three states in spring of 2015 and used by ADRC and other service coordination staff.

Outreach and Training. NASDDDS, UMKC have started a Supporting Families Innovation webinar series. The Series kickoff was held in January (with 246 attendees) and was an overview of the Life Course Framework. The series will continue every other month. The March webinar will focus on changing the Front Door and feature work from Tennessee and Missouri.

RESEARCH COMMITTEE AND EVIDENCE-BASED POLICY The Research Committee met on November 11, 2014. Agenda included updates from NCI, UMN RISP and FISP and Coleman Institute State of the State. UMASS presented information on the recent award of an RRTC grant on Access to Integrated Employment and the field initiated grant on community life engagement. Positive Support Ad Hoc Committee – The Positive Behavior Support Committee (PBS), a subgroup of the Research Committee, is composed of 11 state member agencies, two researchers, and NASDDDS staff. The purpose of the committee is to reach consensus and develop recommendations for the Research Committee and board on:

o Definition of PBS o Staff qualifications and training requirements o Quality and oversight o Proposed policy statement on the use of aversive interventions

The Ad Hoc committee membership has met and recommended definitions on Positive Behavior Supports and Aversive Interventions. The definitions were brought to the

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board in November and approved. One technical amendment on the PBS definition needs to be brought to the board for approval. Staff will take the approved definitions and write a position statement for the board. Additional work by the ad hoc committee is to provide recommendations on staff qualifications and training requirements to the Research Committee. PRESENTATIONS (November through March 15) Nancy Thaler December 3, 2014 Utah Office of Developmental Disabilities and Utah DD Council January 15, 2015 University of Delaware Leadership Institute January 27, 2015 Ohio Association of County Boards of DD February 25-26, 2015 Waves of Change Conference Mary Lee Fay November 10, 2014 AUCD annual conference: Supporting Families February 10, 2015 South Dakota Family Networks: Supporting Families February 25, 2015 NACBHDD: Fostering a Vision and Goal for I/DD Services Dan Berland February 17, 2014 APDDA Association of Professional Developmental

Disabilities Administrators – Emerging Trends and Issues in DD Systems across the United States

Barbara Brent August National Advancing Futures for Adults with Autism Conference September Louisiana Stakeholder Advisory Committee- MLTSS November Arizona Autism Coalition and BCBA Conference February Tennessee Stakeholder Intensive-MLTSS Rie Kennedy-Lizotte January 16, 2015 Milwaukee County Wisconsin:

Developing Systems in Support of Employment Outcomes March 4, 2015 Partnerships in Employment States:

Developing a Competent Workforce Mary Sowers January 15, 2015 Maryland Quality Council March 4, 2015 St. Peter's (Maryland Provider) March 12, 2015 Maryland Resource Coordination Committee Jeanine Zlockie March 12, 2015 Maryland Resource Coordination Committee

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AGENDA ITEM III INFORMATION

Year-to-Date Financial Report / March 2015 PRESENTER Nancy Thaler

REVENUE Total Annual Budget $4,554,263 Year-to-Date Budget $2,801,242 Actual $3,046,515 Difference <$245,273> Variance <8.76%>

Membership Dues 3.10.2015Annual Budget $889,530 Actual $667,947 Total outstanding from 12 of the 51 state members outstanding $221,583

Alaska (unable to pay dues, $5,000), Arizona, California, Florida, Hawaii, Indiana, Kansas, Kentucky, Mississippi, Rhode Island, Pennsylvania, and Wyoming

Special Assessments 3.10.2015Annual Budget $1,866,223 Actual $1,709,000 Total outstanding for the year $159,223

NCI / 42 States (exceeds 40 budgeted); 1 Counties; 21 California Regions $153,393 is outstanding from 8 states

SELN / 29 States (exceed 28 budgeted) $70,000 is outstanding from 2 states

Grant/Contract IncomeYear-to-Date Budget $1,072,541 Actual $689,383 Difference <$382,158> Variance <36%>

Investment IncomeYear-to-Date Budget $20,417 Actual $24,233 Difference $8,817 Variance 19%

Other IncomeYear-to-Date Budget $3,471 Actual $14,052 Difference $10.581 Variance 305%

RegistrationsYear-to-Date Budget $76,708 Actual $83,774 Difference $7,066 Variance 9%

SubscriptionsYear-to-Date Budget $6,417 Actual $6.350 Difference <$67> Variance <1%>

TA FeesYear-to-Date Budget $11,667 Actual $26,127 Difference $14,461 Variance 124%

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PublicationsYear-to-Date Budget $583 Actual $177 Difference <$406> Variance 52%

EXPENSES Total Annual Budget $4,554,263 Year-to-Date Budget $2,656,653 Actual $2,721,425 Difference <$64,771> Variance <2.4%>

Salary and Benefits Year-to-Date Budget $763,370 Actual $820,467 Difference <$57,097> Variance <7.5%> Note: Includes payout staff bonuses ($44,000)

Contract ServicesYear-to-Date Budget $1,520,779 Actual $1,504,212 Difference $16,566 Variance 1%

Travel and Meeting for staff, board, and annual conferenceYear-to-Date Budget $239,405 Actual $248,831 Difference <$8,427> Variance <4%>

Other OperatingYear-to-Date Budget $133,099 Actual $147,913 Difference <$14,814> Variance <11%> Includes rent and related moving costs in new location $15,000

Year to Date Revenue over Expenses $3,046,515 /$2,721,425 Revenues exceed Expenses by $325,090

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FIDUCIARY TRUST FUND REPORT JUN '08 $937,815 JUN '09 $782,866 JUN '10 $870,353 JUN '11 $1,051,805 JUN '12 $1,093,672 JUN '13 $1,216,317 JUN '14 $1,399,226 FEB '15 $1,460,838

Trust Fund Reserve Status Months of Cash Reserves based on annual expenses Minimum requirement three months reserves based on annual expenses

6/30/08 6/30/09 6/30/10 6/30/11 6/30/12 6/30/13 5/28/14 2/28/15 Trust Fund

$937,815

$782,866

$870,353

$1,051,805

$1,093,672

$1,216,317

$1,364,879

$1,460,838

Annual Expenses

$2,143,682

$2,239,166

$2,137,088

$2,183,522

$2,283,383

$2,396,718

$4,434,450

$4,553,263

Months of Reserves

5.25 Months

4.1 Months

4.88 Months

5.78 Months

5.75 Months

6 Months

3.7 Months

3.85 Months

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Year to Year to $ Variance % Variance $ Variance % VarianceAnnual Date Date YTD Actual vs. YTD Actual vs. YTD Actual vs. YTD Actual vs. ProjectedBudget Actual Budget YTD Budget YTD Budget Annual Budget Annual Budget Year End

REVENUE

Membership Dues 889,530 $667,947.00 518,893 149,055 28.73% (221,583) (24.91%) 889,530Special Assessment Dues 1,866,223 1,529,372.08 1,088,630 440,742 40.49% (336,851) (18.05%) 1,866,223Grant/ Contract Income 1,836,927 689,383.23 1,071,541 (382,158) (35.66%) (1,147,544) (62.47%) 1,836,927Investment Income 35,000 24,233.99 20,417 3,817 18.70% (10,766) (30.76%) 35,000Realized Gain/(Loss) 0 5,098.23 0 5,098 5,098 0Other Income 5,950 14,052.26 3,471 10,581 304.87% 8,102 136.17% 5,950Registrations 131,500 83,774.78 76,708 7,066 9.21% (47,725) (36.29%) 131,500Subscriptions 11,000 6,350.00 6,417 (67) (1.04%) (4,650) (42.27%) 11,000TA Professional Fees 20,000 26,127.58 11,667 14,461 123.95% 6,128 30.64% 20,000Publication Sales 1,000 176.65 583 (407) (69.72%) (823) (82.34%) 1,000Staff Travel Reimbursements 5,000 2,917 (2,917) (100.00%) (5,000) (100.00%) 5,000 TOTAL REVENUE 4,802,130 3,046,515.80 2,801,242 245,273 8.76% (1,755,614) (36.56%) 4,802,130

EXPENSES

Salary 1,047,048 665,444.42 610,778 54,666 8.95% (381,604) (36.45%) 1,047,048Payroll Taxes 78,034 44,309.06 45,520 (1,211) (2.66%) (33,725) (43.22%) 78,034Health & Dental Insurance 111,955 66,030.94 65,307 724 1.11% (45,924) (41.02%) 111,955Life & Disability Insurance 15,620 8,513.52 9,112 (598) (6.56%) (7,106) (45.50%) 15,620Retirement Benefits 53,331 34,583.89 31,110 3,474 11.17% (18,747) (35.15%) 53,331Unemployment Comp 450 263 (263) (100.00%) (450) (100.00%) 450Workers Comp 2,200 1,585.97 1,283 303 23.58% (614) (27.91%) 2,200Benefit Allocation (3) 0.02 (2) 2 (101.10%) 3 (100.67%) (3) Sub-Total Personnel 1,308,635 820,467.82 763,370 57,097 7.48% (488,167) (37.30%) 1,308,635

Contractual Services 2,510,508 1,421,149.44 1,464,463 (43,314) (2.96%) (1,089,359) (43.39%) 2,510,508Accounting Services 62,307 44,987.33 36,346 8,642 23.78% (17,320) (27.80%) 62,307Audit Fees 19,000 19,172.74 11,083 8,089 72.99% 173 0.91% 19,000Payroll Services - ADP Fees 2,424 1,707.36 1,414 293 20.75% (717) (29.56%) 2,424Legal 1,500 4,024.16 875 3,149 359.90% 2,524 168.28% 1,500IT support 11,310 13,171.19 6,598 6,574 99.64% 1,861 16.46% 11,310 Sub-Total Services 2,607,049 1,504,212.22 1,520,779 (16,566) (1.09%) (1,102,837) (42.30%) 2,607,049

Hotel Expenses 126,350 83,216.80 73,704 9,513 12.91% (43,133) (34.14%) 126,350Speaker/ Consult Fees (Honoraria) 2,000 5,410.00 1,167 4,243 363.71% 3,410 170.50% 2,000AV Rental & Other 12,642 20,938.07 7,375 13,564 183.93% 8,296 65.62% 12,642Staff Travel 171,560 84,652.98 100,077 (15,424) (15.41%) (86,907) (50.66%) 171,560Board/ Committee Travel 25,432 40,557.39 14,835 25,722 173.38% 15,125 59.47% 25,432Speaker / Consult Travel 72,425 14,056.71 42,248 (28,191) (66.73%) (58,368) (80.59%) 72,425Sub-Total Travel & Meeting 410,409 248,831.95 239,405 9,427 3.94% (161,577) (39.37%) 410,409

Other Expenses 228,171 147,913.25 133,100 14,814 11.13% (80,258) (35.17%) 228,171

TOTAL EXPENSES 4,554,264 2,721,425.24 2,656,654 64,771 2.44% (1,832,839) (40.24%) 4,554,264

NET INCOME FROM OPERATIONS 247,866 325,090.56 144,588 180,502 124.84% 77,225 31.16% 247,866

Unrealized Gain/(Loss) 0 (510.37) 0 (510) (510) 0EXCESS REVENUE OVER EXPENSES 247,866 324,580.19 144,588 179,992 124.49% 76,714 30.95% 247,866

Restricted for management's use only.

NASDDDSRevenue Expense Summary

For the Period of Seven Months Ended January 31, 2015

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AGENDA ITEM IV ACTION Personnel Benefits PRESENTER Nancy Thaler ITEM I HEALTH BENEFITS The Affordable Care Act has changed the options for employers to cover health care benefits. Due to the rising costs of health care, NASDDDS searched for alternative plans and as a result, rejoined the Center for Nonprofit Advancement (CNA) – a Washington based organization that assists nonprofits with management responsibilities including securing health insurance. We enrolled in the center November 1, 2014, and the new health plan became effective February 1, 2015. In the process of enrolling in the new plan, the CNA advised that the association's current practice of offering employees reimbursement for health care was no longer allowable under the Affordable Care Act. In the past, NASDDDS has offered employees health benefits or the option to be reimbursed for private insurance; insurance benefits covered by a spouse; or Medicare supplemental. This arrangement has worked well for both employees and NASDDDS.

NASDDDS Current Personnel Policies Group Medical Insurance

In case of a regular employee who elects to be covered under the group medical plan of a spouse or another relative (rather than seeking individual or family coverage under NASDDDS' group plan), the association will compensate such employee for all out-of-pocket premiums paid exclusively on his or her behalf and 80 percent of the spouse/family, up to the monthly costs NASDDDS would have incurred had the employee elected individual coverage under the association's benchmark group plan. Any employee seeking such compensation will be required to furnish appropriate documentation that such out-of-pocket expenses were incurred.

New Guidance Clarifies Reimbursement of Employee Health Cost from Clifton Larson

A recent Department of Labor (DOL) news release clarifies the restrictions on employer-provided reimbursements of health care costs under the Affordable Care Act (ACA). The release says these reimbursement arrangements, even if reported as taxable payroll to the employee, represent a violation of the ACA market reform rules. This could subject the employer to a penalty as high as $100 per day per employee. The guidance is effective for health plan years beginning on or after January 1, 2014.

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As a practical matter, small employers using reimbursement arrangements are most likely to face this risk. Larger employers with 100 or more employees are subject to a mandate to provide group health coverage to employees beginning with their 2015 health plan year. Those with 50 or more employees face this mandate beginning in 2016.

About a year ago, we explained the new ACA market reform provisions and their adverse impact on small businesses with employer-provided medical reimbursement plans and employer reimbursement of employee individual health insurance premiums. That guidance is generally still valid, but the option of maintaining the health reimbursement arrangement as a taxable fringe benefit is now off the table.

Three Exemptions

Consistent with our earlier communication, there are three arrangements that remain exempt from these market reform rules:

A one-employee health plan An employer-provided group insurance plan, whether furnished alone or

accompanied by an integrated medical reimbursement plan Reimbursement plans that cover only ancillary benefits such as dental, vision,

or long-term care premiums

Prior to this latest DOL guidance, tax advisors generally understood that including reimbursed premiums and other medical reimbursement arrangements in employee taxable wages would avoid the ACA penalties; this was based on IRS "Q and A" guidance issued in May 2014. Because of this earlier status, there should be a "reasonable cause" defense for any prior payments in 2014, assuming corrective action is taken promptly after receipt of a notification. Reasonable cause applies if the employer corrects the failure during the 30-day period from when the employer knew of the DOL requirements.

Take action if you don't meet exemptions

Unless you meet one of the exceptions identified above, employers with health reimbursement arrangements should immediately take three actions:

1. Discontinue any payments or reimbursements of employee individual health insurance policy premiums, and any reimbursements under employer-provided medical reimbursement plans.

2. Rescind any written plan documents, retroactive to the first day in 2014 when the plan was effective.

3. Recharacterize any amounts paid to employees for these reimbursements as taxable compensation.

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http://www.claconnect.com/Employee-Benefit-Plans/New-Restrictions-Employer-Provided-Medical-Expense-Reimbursement-Plans.aspx

Proposed Action The association discontinued the practice of reimbursing employees for health insurance effective December 1, 2014. Salary adjustments were negotiated with each employee in anticipation of board approval of a modification to personnel policies effective December 2, 2014. Adopt Revision to NASDDDS Personnel Policies as indicated with shaded text below effective December 1, 2014.

F. Group Medical Insurance A regular employee is accepted for enrollment and continuing coverage with the association's group medical insurance plan if he or she works a minimum of 30 hours per week and meets all other applicable plan requirements. Health insurance premiums for all eligible employees who chose to enroll in the group plan are covered in full by the association at a benchmark rate established by the association. The association also pays 80 percent of the premium at the benchmark rate for eligible dependents. The balance of the cost of dependent medical coverage and any amount above the benchmark rate which will be withheld from the salary of eligible employees who elect this option. The term "family dependent" includes:

a. The employee's spouse; or b. An unmarried dependent child of the employee or of his or her spouse who is:

(1) under age 26; or (2) age 26 or over, and eligible under the group's eligibility rules due to

dependent status.

A child who is covered as a family dependent, as of the child's 26th birthday or when reaching the group's limiting age, if higher, may continue coverage if incapable of sustaining employment by reason mental incapacity or physical handicap and if chiefly dependent upon the eligible employee for support and maintenance, with proof of incapacity and dependency furnished annually if requested by the health plan; or

c. Any other unmarried dependent child under the group's limiting age for whom the

employee is eligible to claim an exemption on his or her federal income tax return and who is permanently residing in the employee's household.

d. Any unmarried dependent child under the group's limiting age for whom the

employee received a qualified medical child support order. The employee, through the association, must notify the health plan of any change in eligibility of

27

a family dependent for any reason other than when a child reaches the group's limiting age.

Should a regular employee elect not to be covered under the group medical plan, the association will negotiate a salary adjustment in lieu of the group medical plan. New employees will be given pamphlets and brochures that describe the benefits of the group health plan in detail. Employees are asked to read these materials and become familiar with the benefits of the plan as well as their obligations. Any questions concerning health benefits should be directed to the executive director or his or her designee. The association will assist terminating employees to convert their health insurance coverage to an individual plan (COBRA), if they so desire as required by federal guidelines.

ITEM II HEALTH ADVOCATE BENEFIT Health Advocate is an employee benefit plan that offers support to staff in a range of situations related to medical services. Health Advocate is not an insurance program. It is a service to assist employees in accessing health services, managing health care costs, and managing health conditions of family members. Health Advocate provides a wide range of services. NASDDDS has elected to use a narrow range of those services as listed below. The cost of the services is $2.20 per employee per month. The total cost is $290.40 annually. 1. Core Health Advocacy Services

Helps employees and their eligible family members (children, spouses, parents and parents-in-laws) navigate and resolve time-consuming healthcare, administrative and insurance-related issues The program is delivered by a team of highly trained Personal Health Advocates, typically registered nurses, who are supported by experienced medical directors and benefits and claims specialists. Our Personal Health Advocates work with providers and insurance companies on the employee's behalf to in-network providers, obtain second opinions, resolve claims problems and address a wide range of other issues. The Personal Health Advocate remains with the employee until all issues are resolved, and is available for ongoing follow-up. Data-Driven Resources For clients who provide Health Advocate with access to their medical, pharmacy and related claims data,

28

the service includes: Gaps in Care Coaching. Ongoing, tailored "gaps in care" health coaching by

Personal Health Advocates, using our Advocate Health Information Dashboard. Client and Member Information Dashboards. Provides employer-based strategic

overview; identifies and prioritizes gaps in care for employees. Medical cost analysis (baseline and annual). An advanced analysis of your

medical costs and drivers for the current year and annually thereafter. 2. NurseLine™

NurseLine offers employees around-the-clock access to registered nurses for trustworthy guidance to appropriate care, self-care measures to ease symptoms and treat non-urgent conditions, and dependable information about diseases and medications. The integration of the NurseLine with the Core Health Advocacy service means that members can also receive in-depth help for any healthcare or insurance-related issues that may arise, offering multi-level services every day, at any hour.

3. Medical Bill Saver™

Skilled negotiators work with providers to help lower employees' non-covered, post-service medical and dental bills over $400, for significant savings. Employees are not charged any upfront fees to use this service.

4. MedChoice Support™

A comprehensive, interactive tool that combines authoritative medical information and practical personal assessments to help employees weigh the pros and cons of tests, treatments, procedures and medications to make wise decisions about their medical care. A summary can be printed out to share with their healthcare team.

Proposed Action Adopt the Health Advocate as a benefit for full-time employees at no cost to the employee.

29

Proposal for NASDDDS

February 2015

30

For more information, please contact:

HealthAdvocate

Table of ContentsExecutive Summary

Solutions

Pricing

Capabilities

Company Overview

Spectrum of Solutions

Member Communications

Getting Started

HealthAdvocate Proposal forNASDDDS

Kate Gaul

Assistant Vice President, Sales

330.519.4006

[email protected]

31

HealthAdvocate Proposal for

Executive SummaryHealthAdvocate

Section 1

February 2015

NASDDDS32


Executive SummaryHealthAdvocate

Health Advocate is pleased to present this proposal. It describes our innovative, personalized and fully

integrated employee and employer solutions that are designed to save time and money, increase productivity

and improve health outcomes.

The contents include key features of our programs and the Health Advocate advantage – the capabilities of

our highly trained operations staff and experienced management team, our pricing structure, state-of-the-art

systems technology, complete turnkey communications program and streamlined installation process.

The purpose of the proposal is to clearly demonstrate how Health Advocate has achieved unparalleled success

in helping individuals navigate the complex healthcare and health insurance systems, improve their health

and become more effective healthcare consumers, as well as how we help Human Resources departments

administer important programs.

The Health Advocate Advantage

Health Advocate’s key distinguishing factor is the outstanding personalized and dedicated attention provided by

our entire team of highly trained Personal Health Advocates, Wellness and Chronic Care Coaches, EAP+Work/Life

counselors and healthcare, bene!ts and insurance experts, as they help employees and their families resolve

complex issues, improve their health and meet their long-term health goals. We get to know their needs so we

can get the right answers, no matter how complicated or how long it takes. This personalized attention extends

across all issues and programs, whether it’s locating the right doctor, connecting them to the right bene!ts

so they don’t “fall through the cracks,” resolving an uncovered medical bill, or providing them with coaching

to help them reach their optimal health. With help from our dedicated Personal Health Advocates and other

experienced experts, your employees can remain fully productive, health outcomes improve, medical costs are

reduced and the quality of your employees’ overall healthcare experience is enhanced.

About Us

Health Advocate™, Inc., a subsidiary of West Corporation, is the nation’s leading healthcare advocacy and

assistance company serving more than 10,000 clients. We offer a range of solutions to lower healthcare costs,

increase productivity and improve outcomes. West Corporation is a leading provider of technology-driven

communication services.

We Look Forward To Becoming Your Partner

Our staff is poised to work closely with your organization to help you and your employees save time and money.

We invite you to visit our of!ce and take a tour of our operations, to see !rst-hand how our dedicated team can

help you maximize your bene!ts.

February 2015

NASDDDS33


Executive SummaryExecutive Summary

Solutions Snapshot

Health Advocate’s personalized employee and employer-based solutions offer a comprehensive

approach that provides one-source support across a continuum of needs. Our employee solutions

help employees improve their health, make more informed healthcare decisions, better balance work

and life demands, connect to the right bene!ts and lower their medical bills. Our complementary

employer solutions support Human Resources departments in achieving streamlined administration

for a wide range of key programs.

Below is a brief description of the solutions offered in this proposal. Additional information about our

entire suite is available in the Spectrum of Solutions section at the back of this proposal.

Core Health Advocacy

Our Core Health Advocacy program is the cornerstone of what we do. This unique service takes

a highly personalized approach to helping employees and their eligible family members navigate

and resolve time-consuming healthcare, administrative and insurance-related issues and get more

engaged in their healthcare. The program is delivered by a team of highly trained Personal Health

Advocates, typically registered nurses, who are supported by experienced medical directors and

bene!ts and claims specialists. Our Personal Health Advocates work with providers and insurance

companies on the employee’s behalf to !nd in-network providers, obtain second opinions, resolve

claims problems and address a wide range of other issues. The Personal Health Advocate remains

with the employee until all issues are resolved, and is available for ongoing follow-up.

Data-Driven Resources

For clients who provide Health Advocate with access to their medical, pharmacy and related claims data,

our Core Health Advocacy program also includes, at no additional cost, several value-added programs:

• Gaps in Care Coaching. Ongoing, tailored “gaps in care” health coaching by Personal Health

Advocates, using our Advocate Health Information Dashboard.

• Client and Member Information Dashboards. Provides employer-based strategic overview;

identi!es and prioritizes gaps in care for employees.

• Medical cost analysis (baseline and annual). An advanced analysis of your medical costs and

drivers for the current year and annually thereafter.

February 2015

NASDDDS34


NurseLine™

Our NurseLine offers employees around-the-clock access to registered nurses for trustworthy

guidance to appropriate care, self-care measures to ease symptoms and treat non-urgent conditions,

and dependable information about diseases and medications. The integration of the NurseLine with our

Core Health Advocacy service means that members can also receive in-depth help for any healthcare

or insurance-related issues that may arise, offering multi-level services every day, at any hour.

Medical Bill Saver™

Our skilled negotiators work with providers to help lower employees’ non-covered, post-service

medical and dental bills over $400, for signi#cant savings. Employees are not charged any upfront

fees to use this service.

MedChoice Support™

The program offers a comprehensive, interactive tool that combines authoritative medical information

and practical personal assessments to help employees weigh the pros and cons of tests, treatments,

procedures and medications to make wise decisions about their medical care. A summary can be

printed out to share with their healthcare team.

Executive Summary

February 2015

NASDDDS35


SolutionsHealthAdvocate

Section 2

February 2015

NASDDDS36



What is the Health Advocate Core Health Advocacy service?

As the foundation of Health Advocate, and the focal point for our spectrum of solutions, our Core Health

Advocacy service complements your company’s existing bene!ts program by helping employees navigate the

healthcare system and get the most out of their healthcare experience.

The service is centered around our team of highly trained Personal Health Advocates, typically registered nurses

who are supported by a team of medical directors and bene!ts and claims specialists. Our Personal Health

Advocates work one-on-one with employees to help resolve a wide range of healthcare and insurance-related

issues that can be challenging for employees and Human Resources staff. Their primary function is to serve as

liaisons with healthcare providers, insurance companies and health-related community services. By doing all

the work to resolve issues expertly and ef!ciently, our Personal Health Advocates ensure that employees

receive the information and support they need to remain fully productive, save money and optimize their

healthcare experience.

Data-Driven Resources

Clients who provide access to their medical, pharmacy and related claims data also bene!t from our

Health Information Dashboards. Available at no additional cost, these powerful resources provide our Personal

Health Advocates and clients with 24/7 access to critical health, wellness and utilization information.

• Gaps in Care Coaching. Our Health Information Dashboards aggregate and analyze personalized health

data against clinical benchmarks, to identify individual health risk factors and gaps in care. The Advocate

Dashboard provides detailed insight into each member’s health pro!le, enabling our Personal Health

Advocates to provide targeted health coaching at every interaction.

• Client Executive Dashboards. The Executive Dashboards equip our clients with critical insight into the

drivers of medical costs, employee health and wellness measures, savings opportunities and other strategic

information to help them track program effectiveness.

• Member Health Information Dashboard. Our customized Member Dashboard is available to each

employee on a secure, password-protected website. It provides details about their entire bene!ts program,

including real-time utilization and healthcare spending. It also offers “spotlight” reminders about overdue

health screenings and other important tests.

• Medical Claims Analysis. Performed for the most recently-completed year and annually thereafter,

this valuable tool analyzes your medical and pharmacy claims to identify the key drivers of healthcare costs.

Available data includes the percentage of employees with chronic conditions, compliance with recommended

care and treatment, ER utilization and more.

HealthAdvocate

February 2015

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How does the Core Health Advocacy service work?

One, simple call to our toll-free number is all it takes to get help with virtually any healthcare or insurance-related

issue anytime, 24/7.

• Employees will be assigned a dedicated Personal Health Advocate, who will address their speci!c concerns.

• Our work begins immediately, including interacting with insurance companies and providers and doing the

necessary research to help bring each issue to an effective resolution.

• Our experts know the ins and outs of the healthcare and insurance systems, in order to get the right answers

quickly and ef!ciently.

• For example, we can help with a wide variety of concerns, such as locating providers and making

appointments, uncovering claims and billing errors, !nding specialists and eldercare, and explaining medical

conditions and treatments.

• The same Personal Health Advocate works with the employee until all issues are completely resolved,

and is also available to address any follow-up needs.

HealthAdvocate Core Health Advocacy

February 2015

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Health Information Dashboards

In order to provide the following free features, Health Advocate must have access to your organization’s

medical, pharmacy and other healthcare data. Our data experts will transform your data into a series of

customized, web-based dashboards that provide a secure, real-time view of your entire bene!ts experience.

These powerful tools also increase engagement and empower employees to make informed healthcare

choices with a clear understanding of costs and potential outcomes.

Advocate Dashboard

Our Personal Health Advocates have real-time access to each employee’s health and wellness pro!le

through our Advocate Health Information Dashboard. This powerful tool gives them additional opportunities

to engage employees in personalized coaching and support around identi!ed health risks and gaps in care

at each interaction.

February 2015

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Client Executive Dashboards

Our Executive dashboards feature a set of dynamic decision support tools that provide strategic insight into

your cost drivers, employee health measures and savings opportunities.


February 2015

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Member Health Information Dashboard

Our customized Member Dashboard is available to each employee on a secure, password-protected website.

It provides details about their entire bene!ts program, including real-time utilization and healthcare spending.

It also offers “spotlight” reminders about overdue health screenings and other important tests.


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Who is eligible?

Our Core Health Advocacy service is available to eligible employees, their spouses and dependent children,

as well as their parents and parents-in-law. Our clients and members value the expanded eligibility of our

programs, since managing eldercare and other senior issues can often impact the workplace.

What are the features of the Core Health Advocacy service?

• Personal Health Advocate. Personalized assistance from registered nurses, supported by medical

directors and bene!ts and claims specialists, for help resolving a wide range of healthcare and insurance-

related issues.

• Clinical Support. Help !nding the right doctors, obtaining second opinions, researching treatments,

scheduling appointments with specialists, coordinating care and more.

• Administrative Support. Help resolving insurance claims, uncovering billing mistakes, navigating within

an insurance plan and more.

• Healthcare Coaching. Support preparing employees for doctor visits, medical tests and treatments,

and explaining complex medical conditions.

• Information and Support. Assistance with eldercare and Medicare issues, researching wellness services,

transportation and more.

For clients who provide access to claims and utilization data:

• Gaps in Care Coaching. Our Personal Health Advocates use the Advocate Health Information Dashboard

to identify opportunities for ongoing, tailored health coaching and support.

• Client Executive Dashboards. Strategic insight into medical cost drivers, areas for improvement and other

key health, wellness and utilization measures.

• Member Health Information Dashboard. Ongoing, secure access to important bene!ts information and

important health alerts.

• Medical Claims Analysis. Powerful baseline and annual analysis of medical cost drivers, to identify

opportunities to reduce costs and evaluate year-to-year program performance.


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What are the bene!ts of the Core Health Advocacy service?

• Personal Health Advocates do all the work, and are available for unlimited follow-up

• Saves time and increases employee productivity

• Decreases absenteeism

• Helps reduce medical costs

• Relieves worry

• Eases workload of HR staff

• Enhances employee bene!ts

• Helps improve member health outcomes

• Covers eligible family members

• Increases employee satisfaction

• Reduces potential legal and !nancial liabilities

• Promotes more informed, cost-effective healthcare decision-making

• Identi!es actionable gaps in care for health coaching and other opportunities to improve outcomes

(available when data is provided)

• Provides strategic insight into medical cost drivers and aggregate risks and opportunities

(available when data is provided)

• Keeps employees aware of bene!ts utilization and alerts them to important gaps in care and

other health risks (available when data is provided)


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What is the Health Advocate NurseLine program?

The NurseLine program provides employees with at-the-moment assistance from registered nurses, around

the clock. Members are assured of trustworthy guidance to the appropriate care they need at the time of the

call, self-care measures to ease symptoms and treat non-urgent conditions, and dependable information

about diseases and medications.

Having a trained professional to call at any time about medical problems, especially when they cannot reach

a doctor, can help reduce employees’ costly trips to the emergency room.

How does the NurseLine program work?

Members can call the toll-free number any time for assistance. Registered nurses use a state-of-the-art clinical

health information database, protocol for care guidelines and compassionate communication skills to provide

employees with trusted advice. The nurses answer questions about symptoms, medications, home-care

methods, non-urgent conditions and much more. If needed, the nurses can direct employees to appropriate

care at the ER, critical care center or doctor.

Who is eligible?

The NurseLine program assists employees, their spouse and dependent children, as well as their parents and

parents-in-law. Employers and employees !nd our expanded eligibility coverage valuable, as senior issues

increasingly impact the workplace.

NurseLineTM

HealthAdvocate

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What are the features of the NurseLine program?

• Trusted advice from nurses, backed by a state-of-the-art clinical health information database

• As needed, nurses direct members to appropriate care (e.g., 911, ER, doctor)

• Answer questions about symptoms and medications, whether mild or severe

• Offer home-care strategies for non-urgent conditions

• Turnkey communications promote awareness and utilization

• Seamless integration with Core Health Advocacy service for help !nding the right providers and local urgent

care centers, scheduling earliest appointments, resolving billing issues and much more

What are the bene!ts of the NurseLine program?

• Elimination of costly, unnecessary ER and doctor visits

• Available 24/7

• Reduces absenteeism

• Improves productivity, employee satisfaction

• Helps employees make informed healthcare decisions

• Saves time and money

• Seamless integration with Core Health Advocacy service

HealthAdvocate NurseLine

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What is the Health Advocate Medical Bill Saver program?

The Medical Bill Saver program offers our expertise to negotiate lower costs on employees’ non-covered,

post-service medical and dental claims on bills of $400 and over, for signi!cant savings. Employees are not

charged any upfront fees to use this service.

Medical Bill Saver supports consumer-driven health plans, reduces employee out-of-pocket costs, and offers

!nancial relief to both employers and employees.

How does the Medical Bill Saver program work?

When an employee calls our toll-free number about a non-covered medical or dental bill over $400, they will

be directed to send or fax the bill to one of Health Advocate’s skilled negotiators who knows the ins and outs

of billing practices. We will work on the employee’s behalf, regardless of insurance or bene!t status. Using fee

benchmarking databases, the negotiator works with the provider to get a discount that can help the employee

save hundreds, and sometimes even thousands, of dollars. Employees receive a Savings Result Statement

summarizing the outcome.

Who is eligible?

Our Medical Bill Saver program assists employees, their spouse and dependent children, as well as their parents

and parents-in-law. Employers and employees !nd our expanded eligibility coverage valuable, as senior issues

increasingly impact the workplace.

Medical Bill SaverTM

HealthAdvocate

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What are the features of the Medical Bill Saver program?

• Experienced special negotiation team

• Negotiations for non-covered medical and dental bills of $400 and over

• Use of critical pricing trend information, fee benchmarking databases

• Easy-to-read Savings Results Statement provided to employee summarizing negotiation

• Provider sign-off on payment terms and conditions

• Seamless integration with Core Health Advocacy service for help with complex conditions, insurance issues,

!nding the right providers, preparing questions to ask the doctor and much more.

What are the bene!ts of the Medical Bill Saver program?

• “Safety net” for employees with consumer-driven health plans

and health spending accounts

• Successful track record achieving signi!cant savings

• Educates employees about covered and non-covered services

• Can lead to smart healthcare decisions

• Expedites rapid payments to providers, generating

larger discounts

• Reduces medical claims and burden on HR staff

• Increases employee productivity



HealthAdvocate Medical Bill Saver

Member Savings*$2,516

Case Study

Bill Charged ......................................... $5,032

Negotiated Discount ............................... 50%

Resolution: Health Advocate worked with

the provider to signi"cantly reduce the bill.

*The savings on case studies cannot be

guaranteed. Results may vary.

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What is the Health Advocate MedChoice Support program?

Health Advocate’s MedChoice Support program provides a comprehensive, interactive online tool that

helps employees understand their medical care options to make wise decisions about tests, treatments and

medications that are right for them. The self-directed tool guides employees through key health decisions,

combining authoritative medical information about the bene!ts, risks and costs of each option, with practical,

personal assessments that gauge their feelings and preferences about their decision.

Knowing about their options, including pricey and high-prevalence health choices, such as surgery, diagnostic

tests and medications, may lead them to choose a less risky, less complicated and less costly option.

How does the MedChoice Support program work?

Employees log on to the Health Advocate website, select the MedChoice Support tool, and choose a condition

or topic for detailed information. Built on evidence-based information, the individual is guided through six steps

to help them reach a decision. The tool helps them compare options, gauge their feelings, record their concerns,

and assess their preferences and con!dence about their options and decisions. Employees can print out a

decision summary to share with their healthcare team.

Who is eligible?

Our MedChoice Support program assists employees, their spouse and dependent children, as well as their

parents and parents-in-law. Employers and employees !nd our expanded eligibility coverage valuable, as senior

issues increasingly impact the workplace.

MedChoice SupportTM

HealthAdvocate

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What are the features of the MedChoice Support program?

• Updated, physician-reviewed information on conditions from A-Z

• Covers more than 150 decision topics, such as surgery, diagnostic tests and medications

• Details less costly or less risky options, with fewer complications, shorter recovery times

• Compares bene!ts, risks, costs, side effects, recovery, outcomes, etc.

• Practical assessments help gauge personal needs and wants

• Printable summary to share with healthcare team

• Seamless integration with Core Health Advocacy service for help with complex conditions, billing and

insurance issues, !nding the right providers, scheduling earliest appointments and more

What are the bene!ts of the MedChoice Support program?

• Comparative measures support consumer-driven health plans

• Latest, authoritative information leads to less costly decisions and better care

• Informed employees may be less likely to use inappropriate care

• Promotes shared decision-making

• 24/7 access

• Helps employees take responsibility for their health


• Saves time and money


HealthAdvocate MedChoice Support

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PricingHealthAdvocate

Section 3

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PricingHealthAdvocate

The pricing for the programs included in this proposal are as follows:

Programs

________________________________________________________________________________________________


NurseLine+Medical Bill Saver+MedChoice Support________________________________________________________________________________________________

TOTAL

Notes

Pricing is based on Health Advocate's standard 3-year agreement; all terms and

conditions apply.

Eligibility: The fee covers eligible employees, their spouses, dependent children, parents

and parents-in-law, except as otherwise noted.

Communications Materials: Health Advocate will provide our standard communication

materials to the client for distribution to employees enrolled in the program.

Covered Employee Lives: Based on a population of [XXX] employees.

Cost

$1.50 PEPM

$0.70 PEPM

$2.20 PEPM

February 2015

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February 2015 51


CapabilitiesHealthAdvocate

Section 4

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CapabilitiesHealthAdvocate

Below is a brief summary of our capabilities that support the offerings in this proposal. Health Advocate has

invested in a highly trained, highly experienced and ever-growing team of healthcare and wellness experts.

Our investment also includes the latest, integrated telephone and database technologies that enable us

to provide outstanding service to our clients.

Health Advocate is committed to offering state-of-the-art upgrades, re!nements, improved strategies and better

systems, as well as ongoing training of our staff to ensure that our clients receive consistent, quality service.

We work closely with our clients to ensure seamless installation of our programs, and have developed a robust,

turnkey communications program to help support broad awareness and utilization of our service.

Superior Team Quali!cations

Health Advocate’s founders have more than 100 years of combined experience in the healthcare industry,

and have recruited extremely talented and experienced individuals to comprise our management and service

teams. Our company possesses superior operational, medical, technical and administrative expertise to meet

the diverse needs of our clients.

Our Team

Our staff is continually trained in navigating all aspects of the healthcare system, to provide the best assistance

and support to employees and employers.

• Personal Health Advocates. Typically registered nurses, supported by medical directors and bene!ts and claims

specialists, our Personal Health Advocates have extensive clinical experience; most have worked for hospitals

or physicians. The ability of our knowledgeable staff to resolve burdensome issues in a compassionate and

dedicated manner is a hallmark of Health Advocate’s Core Health Advocacy service.

• Wellness Coaches. All of our skilled Wellness Coaches have a bachelor’s degree in a health-related !eld

and complete a training period with a senior coach. They are also certi!ed in tobacco cessation counseling by

the American Lung Association, and hold at least one additional certi!cation in a relevant specialty (e.g., exercise

physiology, nutrition, health education).

• Chronic Care Coaches. Typically registered nurses, our Chronic Care Coaches are supported by medical

directors. Most have over 10 years of experience caring for patients with complicated medical problems,

including the chronic conditions supported by the Chronic Care Solutions program. Many have been clinical case

managers prior to joining Health Advocate, and have added training in coaching individuals with chronic disease.

• Licensed Professional Counselors and Work/Life Specialists. Our team of Licensed Professional Counselors

and Work/Life Specialists deliver our comprehensive EAP+Work/Life program. These trained professionals are

experts in a diverse cross-section of specialties including family/parenting issues, stress management, grief and

loss, depression and more.

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Capabilities

• Onsite Biometric Screening Staff. Our trained screening professionals include registered nurses, EMTs,

paramedics and health educators. All of our nurses have a state nursing license and must pass the National

Council Licensure Examination. Our EMTs and paramedics must pass the National Registry of Emergency

Medical Technicians exam and possess any state-required licensing. The staff is fully trained and in

compliance with all HIPAA privacy regulations.

• Medical Directors. Our Medical Directors have many years of clinical practice experience and support each

clinical case, communicating with physicians and other professionals, as needed.

• Bene!ts and Claims Specialists. Our experts have extensive experience in employee bene!ts or claims

management for health plans.

• Infrastructure Support Staff. Our IT team has extensive experience and training, including senior-level

experience in applications, data and systems architecture and management, to ensure that our integrated

telephone, computer and database technologies fully support our capabilities. The team also ensures that

our customized member websites allow easy access to the speci!c solutions offered by the client for their

employees, and that our reporting tools create better ef!ciencies to fully support their employees.

• Management Team. Our executive management team includes our !ve founders, who previously led one

of the nation’s largest health insurance companies, and our highly experienced senior managers and other

key executives. Our team has operational, medical, technical and administrative expertise and is uniquely

quali!ed to manage a complex organization while meeting the diverse needs of our clients.

• Ongoing Hiring and Training. We continually recruit candidates who have the expert skill set required to

meet the growing needs of our clients. Our ongoing training and collaborative information-sharing programs

ensure that our team is always up to date on healthcare developments, case outcomes and system upgrades.

Innovative Technology

To enable our Personal Health Advocates to ef!ciently access client bene!t information, expand on our present

services and support our clients’ needs for data integration, we have made a considerable investment in

scalable, innovative, state-of-the-art telephone and computer systems.

Health Advocate’s comprehensive online Customer Relationship Management (CRM) system provides an

integrated environment in which all user bene!t information is assimilated and accessible at the time of an

employee’s call. The system links relevant information including eligibility !les, health bene!t information,

and accompanying program information from dental, prescription, medical and other bene!ts. Our computerized

call switching system can warm transfer calls to other vendors as appropriate.

Detailed case tracking protocols enhance knowledge-sharing among our Personal Health Advocates,

and ensure timely resolution of cases. Further, our system includes sophisticated call tracking and reporting

capabilities, enabling Health Advocate to measure call center performance as part of our ongoing quality

assurance program.

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Capabilities

All operations are centralized in our expansive headquarters in suburban Philadelphia, enabling resource

sharing, face-to-face collaboration among team members on all levels, and ensuring a coordinated response to

the employee’s needs.

Health Informatics Division

Health Advocate’s health informatics division, Engage2Health, provides health informatics solutions to support

employers and employees in achieving improved health outcomes and reduced healthcare costs. The division’s

state-of-the-art technology, advanced algorithms and software systems maximize healthcare data to facilitate

our proprietary Health Information Dashboard, wellness and engagement programs. The unit is headed by

a leading health informatics authority and staffed by skilled programmers, statisticians and researchers with

extensive experience performing complex analyses of healthcare data.

Implementation Planning

Health Advocate works closely with our clients to ensure the smooth installation of our program. Our experience

working with organizations, from large national companies to smaller local and regional employers, allows us to

customize an Implementation Plan to meet your speci!c requirements. The following are key elements of our plan:

• Account Manager support

• Focused resources

• Flexibility with launch phase-in

• Comprehensive communications

• Ongoing review

Turnkey Communications

Our ongoing print and electronic communications include a wide range of materials designed to educate

employees about our services and to increase utilization. Many of the materials, such as our newsletters, are

designed to be easily forwarded to employees in a timely manner while our convenient websites provide easy

access to program information. Spanish-language versions are available, and, for an added cost, our team will

work with you to develop customized materials to meet your needs.

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Capabilities

Information Reporting

Health Advocate’s comprehensive Group Information Reports provide critical program utilization and savings

information in a user-friendly format. Our reports measure performance and report results on an interaction

basis, listing by major category each activity Health Advocate has worked on through the reporting period.

We report on the time our staff has expended and on the number of discrete contacts required to resolve an

issue. In addition, all activities are assigned an intensity factor that re#ects the seriousness, complexity and

urgency of the matter. We measure “value” based on the combination of utilization, urgency, time spent, and

number of contacts between our Personal Health Advocates and employees. Further, we report and identify

savings that accrue to either plan sponsors or employees.

The Chronic Care Solutions program reports a wide variety of program-level and condition-speci!c metrics to

evaluate program engagement and effectiveness.

Independent Service

Health Advocate is independent of any insurance plan or third party provider, enabling us to provide completely

unbiased assistance. Our team is fully compliant with all HIPAA privacy regulations.

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Company OverviewHealthAdvocate

Section 5

February 2015

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Company OverviewHealthAdvocate

About Health Advocate

Health Advocate™, Inc., a subsidiary of West Corporation, is the nation’s leading healthcare advocacy and

assistance company. Health Advocate serves more than 10,000 clients offering solutions that save time and lower

healthcare costs. Our award-winning solutions include EmpoweredHealth, Health Advocacy, Wellness Coaching,

EAP+Work/Life and Chronic Care Solutions, among others. We also leverage the power of data analytics to help our

clients and members get more value out of the healthcare system.

Our client base includes large and small insured and self-insured employers, government bodies, unions and

union health and welfare trusts, af#nity groups, nonpro#t and charitable organizations, schools, school boards and

universities, health plans, third-party administrators and other plan sponsors in virtually every industry.

History

Health Advocate was founded by #ve former executives of one of the nation’s leading health insurance

companies. Equipped with unparalleled, combined experience in the healthcare industry, the founders envisioned

a way to help alleviate the frustration and complexity that many people experience when confronting healthcare

and insurance-related issues. Under their leadership and building upon this mission, the company has grown to

become the largest healthcare advocacy and assistance company in the country.

In 2014, Health Advocate became part of West Corporation, a leading provider of technology-driven

communications services, serving Fortune 1000 companies and other clients in a variety of industries including

healthcare, telecommunications, retail, #nancial services, public safety and technology.

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Company Overview


Health Advocate offers a full range of employee and employer solutions that provide personalized help across

a continuum of healthcare and insurance-related needs.

Our solutions help employees take charge of their health, make smarter medical decisions, quickly connect to

the right bene#ts, balance work and life demands, understand consumer-driven health plans, and lower medical

bills. Our employer solutions promote improved health outcomes and reduced medical costs by keeping

employees healthier and more productive. They also help ease the burden of administering multiple programs

by integrating key services onto one coordinated platform.

The company also offers a direct-to-consumer service, Health Proponent®, that provides the same expert,

personal assistance with healthcare and insurance-related issues to individuals who are not part of groups.

Company Culture

Maintaining our high standards of performance takes a lot of hard work. It requires ongoing nourishment by a

culture which is sustained by a deeply-held and shared set of values. “Always at your side” is not just a motto;

it is what makes our company so special. Our employees are responsible for helping people deal with

challenging healthcare and insurance-related issues, which require not just expertise, but empathy and

communication. Consequently, we have built our company around empowering our employees with the ability

to provide maximum support to our clients.

In addition to promoting teamwork, we ensure that employees not only have the resources they need to serve

our members properly, but that our work environment can be structured to allow employees to enjoy themselves

within the context of their important work. We have created a supportive workplace, offering fun activities, family

events, and health and wellness programs throughout the year.

Charitable Contributions

Health Advocate’s commitment to helping people extends to local, regional and national charities. Throughout the

year, both employees and the company raise money for and donate time to a variety of charitable organizations,

including: the American Heart Association, the Sandy Rollman Ovarian Cancer Foundation, Inc., The Children’s

Hospital of Philadelphia, Police Athletic League, American Cancer Society, local police departments, local

theater, local colleges and universities, local ambulatory services, etc. We also forge strategic partnerships with

leading regional and national organizations to promote awareness of important health issues, including breast

cancer prevention, heart health and Alzheimer’s disease.

Customer Satisfaction

Our mission is to provide compassionate, resourceful and quality service to clients and employees. Numerous

customer surveys report the highest level of satisfaction and praise for the dedication and perseverance shown

by our Personal Health Advocates to resolve even the most dif#cult challenges. If you would like references,

we would be happy to share case studies with you.

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Company Overview

Awards/News Media Coverage

Health Advocate has received widespread recognition from the following organizations and publications:

• America’s fastest growing private companies – Inc. 500 (2007 - 2013)

• Fastest growing technology companies in North America – Deloitte’s Technology Fast 500 (2010 - 2013)

• Worldwide Leader in Service – Workforce Management magazine Optimas Award

• PACT Life Sciences Company of the Year Award (Greater Philadelphia Region)

• Entrepreneur of the Year (Greater Philadelphia Region) – Ernst & Young

• InformationWeek Top Tech Innovations

• Top 20 Best Places to Work – Philadelphia magazine and the Philadelphia Business Journal

• Mobile Application Awards for SmartHelp and Health Cost Estimator Apps - Web Health AwardsSM | MOBILE

• Inc. Hire Power Award for New Job Creation (Pennsylvania)

Health Advocate has been featured in hundreds of national, regional and local print articles, radio and TV

news stories, including: BusinessWeek, The Wall Street Journal, The New York Times, The Washington Post,

The Philadelphia Inquirer, the Los Angeles Times, The Atlanta Journal - Constitution, Crain’s New York Business,

USA Today, U.S. News & World Report, CBS Evening News, NBC 10 TV, Fox 29 News (Philadelphia) and

National Public Radio.

Publications

Health Advocate has published a number of in-depth white papers on a variety of timely subjects impacting

the workplace, including the challenges relating to the rising rate of obesity, stress and caregiving.

In addition, two of the company’s founders co-authored The Healthcare Survival Guide™. This valuable

resource has been widely acclaimed and is the winner of the 2010 IBPA Benjamin Franklin Award for Best First

Book (Non-Fiction) and the 2010 APEX Grand Award for One-of-a-Kind-Publication.

About West Corporation

West Corporation is a leading provider of technology-driven communication services, serving Fortune 1000

companies and other clients in a variety of industries, including healthcare, telecommunications, retail, #nancial

services, public safety and technology. Founded in 1986, West has over 32,600 employees worldwide, working

from 41 locations.

Company highlights:

• World’s largest conferencing provider (InterCall)

• Nation’s leading provider of public safety services

• 90% of the Fortune 10, 89% of the Fortune 100 and 84% of the Fortune 500 use West Corporation

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Spectrum of SolutionsHealthAdvocate

Section 6

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Spectrum of SolutionsHealthAdvocate

Health Advocate offers a spectrum of fully integrated solutions. Our programs help employees improve their health,

make smarter medical decisions, balance work and life demands, connect to the right bene!ts and lower medical bills.

All of our solutions promote improved health outcomes and lower costs for both employees and their employers.

Our employer solutions ease the burden of administering multiple programs, including internal and external appeals,

bene!ts enrollment and family leave requests.

The following is a brief description of our entire suite of solutions, some of which may have been described

in this proposal.

Wellness Coaching

Our Wellness Coaching Program offers a proven

approach to engage and support members in

modifying unhealthy behaviors to get – and stay –

healthy. A Personal Wellness Coach works

with employees by telephone, email or instant

message to help them make healthy lifestyle

changes and reach their personal health goals.

What makes our program distinctive is our

coordinated approach. We combine personalized

one-on-one coaching, interactive events and

health data analysis to improve health outcomes,

reduce costs and extend lives.

EAP+Work/Life™

EAP professionals provide short-term assistance

and support for personal, family and work/life

issues, and assist HR staff with sensitive issues.

Core Health Advocacy™

Our Core Health Advocacy program is the

cornerstone of what we do, taking a highly

personalized approach to helping employees

navigate and resolve time-consuming

healthcare and insurance-related issues.

Delivered by a team of highly trained Personal

Health Advocates, typically registered nurses

supported by medical directors and bene!ts

and claims specialists, the program helps !nd

in-network providers, obtain second opinions,

resolve claims problems and address a wide

range of other issues.

EmpoweredHealth™

EmpoweredHealth is a powerful, one-stop

solution that connects employees to a

complete range of personalized and integrated

services including advocacy, wellness,

employee assistance and chronic care

support—all through a single, toll-free number.

Encourage Better Health and Well-Being

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Encourage Better Health (cont’d)

Data Analytics™

Leading-edge analytics drive interventions

that improve outcomes and strengthen

employee engagement.

Bene#ts Gateway™

Live bene!ts experts connect employees to the

right bene!t through a single toll-free number.

Health Information Dashboards™

Technology analyzes employee bene!t, health

and wellness information to leverage “teachable

moments” and address “gaps in care.”

Personalized Health Communications™

Tailored communications remind employees

about important preventive care, while advanced

information systems identify those with chronic

health conditions to help them better manage

their disease.

Pinpoint Solutions: Dashboards and Analytics

Provides access to key performance indicators

and risk pro!les to easily pinpoint costs

and trends.

Improve Health Outcomes

Chronic Care Solutions™

Chronic Care Solutions is a population-based

health program that uses a unique predictive

modeling approach to identify and risk stratify

members who have (or are at risk for) one or

more common chronic conditions. It provides

personalized support across the spectrum of risk

level, tailored to each individual’s speci!c needs.

Onsite Biometric Screenings™

Provides an accessible, dependable way to

get the crucial baseline data needed to tailor

wellness programs for the highest impact.

Incentive Management™

Help creating and tracking customized

engagement strategies and programs.

Tobacco Cessation™

A 12-week program that features personalized,

telephonic, email or instant message-based

coaching using evidence-based strategies to

help employees become (and stay) tobacco-free.

NurseLine™

Provides 24/7 access to registered nurses for

advice about non-urgent medical conditions

and answers to general health questions.

Promote Healthy Behaviors

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Enrollment Advocate™

Specialists educate employees about bene!ts

options, including explaining the details of

consumer-driven health plans.

FMLA Support™

Independent medical team helps verify employee

requests for medical leave, in compliance with

the latest regulations and privacy laws.

Independent Appeals Administration™

Experts provide self-funded companies with

!duciary responsibility for the appeals process

with impartial appeals analysis, in compliance

with all regulations and timelines.

External Appeals Administration™

Helps companies with self-funded plans meet

federal requirements for independent reviews

within strict timelines.

Support Streamlined AdministrationDrive Cost-Effective Decisions

Strengthen Organizations

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Member CommunicationsHealthAdvocate

Section 7

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Exclusively for Health Advocate Members

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Getting Started: Next StepsHealthAdvocate

Section 8

February 2015

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To initiate the Health Advocate program and ensure a smooth installation, we would be happy to arrange

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February 2015 69

AGENDA ITEM V ACTION Fiscal Year 2015-2016 Dues Increase PRESENTER Nancy Thaler BACKGROUND The association's dues for FY 2015-2016 must be established in order to issues membership invoices. This is the fifth and final year of phasing in the new dues structure which is now based on the size of each state's expenditures as reported in the State of the States by David Braddock. In the fourth year, FY 2014-2015, most states reached the target dues, several continued to phase in. For FY 2015-2016 we need to now shift to building in a cost of living factor. The Society for Human Resource Management (SHRM) has reported that U.S. employers are expected to grant a median base salary increase of 3 percent in 2015. Since labor is 90 percent of NASDDDS budget, the SHRM determination is the most applicable standard as compared to Soc. Security rates projections or the various CPIs that are calculated for the economy in general. The recommended increase for FY 2015-2016 is 3 percent. The new rate categories will be: $120M - $300M $ 5,150 $301M - $500M $10,300 $501M - $1B $20,600 $1B - $2B $25,750 $2B - $4B $41,200 $5B and up $51,500 There will be four states that jump to a new dues rate. Missouri, Maryland, Virginia and Washington all exceeded the $1 Billion threshold. Arkansas and Colorado in the final phase in years. D.C. dues will decrease to a lower rate.

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2015-2015 Membership Dues

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AGENDA ITEM VI ACTION Statement on the Rights of People with Cognitive Disabilities To Technology and Information PRESENTER Nancy Thaler

BACKGROUND

The Coleman Institute for Cognitive Disabilities was established in 2001 by the Regents of the University of Colorado. A private endowment and sustained annual contributions by our founding donors, William T. and Claudia L. Coleman, support the Institute's activities through the Coleman Colorado Foundation (CCF), which was established to receive gifts from the donors. The CCF is a 501(c)(3) public charity classified as a 509(a)(3) supporting organization to the University of Colorado (CU) to support the Coleman Institute.

The mission of the Coleman Institute for Cognitive Disabilities is to catalyze and integrate advances in science, engineering, and technology to promote the quality of life and independent living of people with cognitive disabilities. The Institute is committed to providing scientific, technological, and public policy leadership to strengthen the voice of persons with cognitive disabilities and their families in our society.

The Executive Director of the Institute is David Braddock, PhD, who is also Senior Associate Vice President of the University of Colorado system and holds the Coleman-Turner Chair in the School of Medicine, Department of Psychiatry at CU's Anschutz Medical Campus. http://www.colemaninstitute.org/declaration The Coleman Institute has launched a declaration of The Rights of People with Cognitive Disabilities to Technology and Information Access and is soliciting the sign on of all national associations related to people with developmental disabilities. Facts about the Declaration Why is this declaration important?

The Rights of People with Cognitive Disabilities to Technology and Information Access is a statement of principles on the rights of all people to inclusion and choice in relation to technology and information access. The declaration builds on the recognition of the rights of people with intellectual and developmental disabilities to be integrated into the community. Decades of advocacy by parents, people with disabilities, and conscientious professionals in the field have resulted in the principles of inclusion and choice being codified in laws, policies, and practices affecting people with disabilities and their families. This declaration moves the discussion into the realm of one of the newest expression of community integration: the use of technology to socialize with others, share common experiences, participate in government, have access to education, and engage in commerce.

Why is it important that the declaration be released now? The pace of the digital age is accelerating rapidly through new innovations, such as those in cloud computing, where the potential positive impact of cloud-based initiatives include not only improved personal communications, but also health promotion, disease prevention, enhanced social interaction, and individualized supported employment opportunities such as remote job coaching. Technology and information access today is

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http://www.colemaninstitute.org/contact-us/8-about-us/80-braddock-biography

http://www.colemaninstitute.org/declaration

no longer a luxury; it is essential for people with cognitive disabilities to have the same access as their peers without such disabilities in order to fully participate in the worlds of today and tomorrow. Human-centered computational support technologies must be adapted or uniquely developed and properly disseminated to match the unique needs and preferences of individuals with cognitive disabilities. Advancing the rights of people with cognitive disabilities to technology and information access is an extremely important next step in the worldwide implementation of inclusion and choice

This declaration has been endorsed by 236 organizations and 457 people. Harvard Law School Project on Disability American Association on Intellectual and Developmental Disabilities Washington, D.C.

American Network of Community Options and Resources Alexandria, Virginia

APSE

Association of University Centers on Disabilities Silver Spring, Maryland

Autism Society of America Bethesda, Maryland

Autistic Self Advocacy Network NADD

The ARC UCEDDs and DD Councils

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ITEM VII DISCUSSION Board Calls to State Directors PRESENTER Nancy Thaler BACKGROUND Each year board members place calls to state directors to talk with them about the association's services, the needs of their states, and whether there are areas the association might address that it is not now addressing. When directors are unaware of the association's services, the director can provide information on how to use the association. Information from the calls is used by the staff to improve operations. The discussion guide for the calls:

Discussion Guide

Board Contacts with State DD Directors Do you feel connected to the association and other state directors. Do you feel

comfortable calling NASDDDS for information or assistance?

What are the most challenging issues your state is facing at this time? (Budget; relationship with CMS; lawsuits; changes in state government, etc.)

Nancy Thaler, the Executive Director of NASDDDS, will be leaving at the end of Sept. 2015. The board has established a succession planning committee and part of our work is outreach to current directors.

What is the greatest opportunity that you think will support the future success and

stability of NASDDDS? (OK for respondent to offer 2 or 3 opportunities.)

What is the biggest challenge or threat to NASDDDS' ongoing success?

Is there one thing that you hope is preserved when the executive transition occurs?

What do you consider to be the top three priorities that the new executive will

need to address during his/her first 12 to 18 months on the job?

The search for Nancy's successor will launch early in 2015. If you have suggestions for prospective candidates or nominators, I would encourage you to share those names/contact information with Ginna Goodenow at [email protected].

Would you be interested in serving in any of the following capacities?

A member of the NASDDDS National Policy Work Group? A member of the association's Research Committee?

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mailto:[email protected]

Summary of Reports from Board Contacts with State DD Directors

State

Do you feel connected

Most challenging issues your

state is facing

The greatest opportunity

The biggest challenge

Florida Barbara Palmer Michael Airs – chief of staff Lisa Robertson – strategic planning & projects Ed – QM/behav services, assessments

Comfortable reaching out to NASDDDS & gotten information needed

Change how they do business to address service needs & change funding. Difficult to serve people who have dual diagnosis & emerging issue with people with Alzheimer's; employment Forensic initiative

NASDDDS to help states design their future & then get CMS to support the needed change; more opportunities to connect with other states not just about the issue but to see what follow up & outcomes were of that ListServ requests; Would like to see a Website – being able to post best practices… Benchmarking

Contact & structure to help states with strategic planning & reform work

Nebraska Jodi Fenner

Absolutely – no hesitation

Budget; relationship with CMS; lawsuits; changes in state government, etc.)

Never been a time where states need association more than they do right now (managed care, HCBS rule, conflicting policies between CMS/DOJ /HUD, etc. Helping states to manage & implementation these changes Need collaboration & continuity of what association brings to state agencies as they move forward with these contentious issues & bring presence to federal government that individual states cannot

Must watch not making statements that will create division among states based on red/blue Engage & help new directors know how to be engaged & involved with policy decisions. Engage new members so they understand & feel part of the assoc & understand values/ policies (schedule a director's dinner & keep them engaged so that they are bringing issues to the table & staying relevant.)

Oklahoma Joann

Comfortable with NASDDDS. Relatively new director. As she came into the job felt totally supported by NASDDDS. Bernie called & said he was there. She

10 individuals are left in a state facility & now the filed a lawsuit filed to prevent closure. Not worried but have to deal with it.

Charismatic leader is necessary for success (Nancy has good balance of traits to be personal, & visionary – cut through B.S.) Continue to have good

No big threat. Association always has terrific leaders & in a terrific position to carry on & continue the tradition that makes it a meaningful association.

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called him & appreciated the help. When she took the job, intent was to close state facilities, ran into problems with media, & called Nancy. She got exactly what she needed that evening to address her PR problems. Cannot express enough how she feels that there is a personal dedication by each staff person to listen & help – whether large or small issues. Nancy is a tremendous leader & advocate. Appreciated the discussions with other states. Benefit from membership – very important to maintain membership

State faces budget shortfall, & concurrent cuts in state taxes. No light at the end of the tunnel – each session is more & more conservative & less focus/funding on services. Waiting list issue (7,000) even though providing other assistance, people are eligible for & need services through HCBS CMS regulations will require a lot of work but can meet the new requirements. The state was slow to develop community services so not a lot of brick & mortar to maintain. Focused on outcomes based service models that should be able to adapt successfully.

discussions now that new regulations out & design the future programs. Use regulations to move system to serve people in better ways & deal with funding & other pressures at a state level. Look at where there are opportunities with the new rule & how each state is dealing with this & what is most promising. Oklahoma doesn't have large sheltered workshops & can't afford to lose providers so how to help them morph their services, & have it be a win-win situation

Virginia – Connie Cochran

More connected with NASDDDS (Robin & Nancy), not so much with other directors Spread too thin – not much of a chance to reach out & engage with others

Reformatting three waivers to have a new one – working with Robin Cooper

Two years in settlement agreement

Closing centers Taking advantage of DOJ settlement – CMS working with them. Large waiting list State legislature with parents trying to stop closure of centers System transformation Community Services Boards (40

Book good to great… Medicaid & managed care are critical. How do use managed care to get outcomes with waivers & break down silos with housing & beyond DD population How does NASDDDS help build system that are more reflective of younger population & workforce? - One day meetings with directs more valuable than conference & would want to see two days of director interaction than

Who are the leaders who understand the challenges of building systems system change & can maneuver & help directors maneuver the political environment?

79

of them) – hardened traditional system in company Creating regional system without legislative authority State still operating in silos Conflict between parts of government without coordinated effort

conference. Would have to be structured to be good use of time.

Wyoming Chris Newman Joe & Jamie

Chris oversees behavioral health plus DD, so Joe & Jamie run the DD program Joe Simpson – meetings & networking absolutely essential to learn what is working & not working Listservs targeted, well put together, easy to follow track, use it This organization does a very good job.

DOL changes & possible impact due to new rules CMS HCBS Transition Plan Reshape provider system to comply with new standards & help them transform their business models Work & career development… transforming waiver – how to help partners in field better understand work options & career options to better serve people rather than group enclaves & group day hab. How to better individualize services What are fair rates? Providers haven't seen rates & taking a toll. How to reward providers with adequate compensation Struggle with states with dual diagnosis (MH, substance abuse, DD, challenging behaviors) Don't have good programs or approaches Similar to

Clear outline about NASDDDS mission vision, strategic planning Manage resources Because NASDDDS brings on specific talent to staff, & states want to know who is available & could do more contracting with NASDDDS to help with sustainability Work on mini projects where states could come together on a topic & NASDDDS support the facilitation & focus on the topic Help states get best bang for buck. Let additional fee be included in a "tiered" membership Build a partnership network & have NASDDDS share a piece of the ultimate fees for bringing business

Losing Nancy - - don't say Robin is retiring too. Need to generate enough income to be self-sustaining & new business opportunities. Not brokering relationships with members who are willing to contract & help pay Need to get better data & evidence & hands on assistance to set programs up that response to specific needs. NASDDDS could help, but without help from NASDDDS, will have to go elsewhere. They pay too much for other consultants where NASDDDS could

Montana – Novelene Martin North Dakota – Tine Bay

Yes, they use NASDDDS a lot, especially the two folks work solely on waivers. Every other

Transition plan creates challenges for them. Still have an ICF, Legislation introducing

Sense is that NASDDDS has forged some strong collaborative relationship with other national

Communication with CMS, she knows that NASDDDS has worked really had at that. Effort

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Vermont – Camille George

week she would guess. Often talk with them.

Feels more connected than she did this time last year when she did these phone calls. She has attended some of the conferences & gotten to know people. She has always felt comfortable calling NASDDDS, staff & other state directors. She would like to make even better connections & improve the connections that she has already made. Absolutely, both her personally & her staff. Staff in the division use the list serve extensively.

Travel may be restricted in the future due to budget constraints.

Loves NASDDDS & is really appreciative of all the support that N---- provides. Mentioned Mary Lee Fay & Robin Cooper specifically as being really involved & helpful.

bill that introduces closure of the facility. Community providers have waiting list because of capacity now, this will make this more challenging. Rate system pays the same for all people, no difference with difficulty of the person. About 54 people remaining in the ICF. Think there are about 12 that can never be served in community.

Forensic population also presents unique challenges. Reduction in the budget, getting the budget cut.

Increase in people coming to the state; therefore increase in the number served. Recently ran out of availability to serve people in the waiver. Currently does not have a waiting list. Autism services in the state plan. They have a waiver; try to plan ahead for this change is difficult. A lot of unknowns at this time. State budget situation is downward, very concerning. Furloughs are being discussed. Worse than it has been in several years. Extended period

organizations. She thinks the opportunity to maintain & strengthen those relationships. Good to present unified positions, this is an opportunity.

She is not as involved as some other states, so she is less involved.

To have someone who has been a director previously, that knowledge & expertise is vital to the role & understanding what the states need.

The commitment from the states in terms of seeing the variety of resources that NASDDDS can offer. NASDDDS can meet each state where they are & provide support. Can work with what is unique to that state to maintain success & stability.

must continue. The direction of CMS can be a real problem for the states.

Individual state budget challenges sometimes means that a state may not be able to take advantage of all the resources NASDDDS offers. Needs to keep membership dues manageable for the states. States sometimes sit around scratching our heads, it is the public perceptions. DD/ID can still be a very marginalized group. Sometimes it is difficult to find the support to provide the quality of services that are needed. The average person does not have the person investment. NASDDDS needs to continue to keep the awareness up at a national level, including the wonderful contributions people with DD can make. She does not know, may be challenging for states budgets to pay dues. How much do they spend on every little thing? May be difficult to attend or pay dues. NASDDDS needs to be able to defend the importance of the membership.

81

of lack of resources to do what needs to be done. Specifically some of the quality assurance needs. In prior years her agency lost a good deal of staff (prior recession) & they have not been able to rebuild. They are starting to see the impact of her agency's inability to be out there as much as they used to.

Relationship with CMS, Vermont is unique in that they have two large 1115 waivers (no C waivers). Discussion about consolidating their two waivers especially in light of the new HCBS Final Rule.

No major systemic law suits at this time. Changes in local state governments have not had a major effect on people. Have had the same commissioner since 2007. But have some re-organizations during that time.

Wisconsin Feel very supported; Appreciate Dan's updates on National perspectives (companionship rules etc.) Robin Cooper is a great resource

Intensive Autism services, move from waiver to EPSDT; complex needs of forensic folks, but have had recent success partnering with DOC; old guard families (VOR) concerns of eroding funding

Credibility; understanding services at the state level, experience in management of a State program; continue to have subject matter experts.

Changing policy

Massachusetts Feels connected; Choose Nancy for National perspective as well as Mary Lee. Gail Grossman &

Community rule; opposition on the draft plan- setting unclear; Families with kids with autism

Changing landscape

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Janet George also feel connected & supported

want congregate settings; issues with bed size for homes, providers want more than 5; day programs on campus; need to develop an instrumentation for outcomes for people. Deficit 100 mil, emergency reductions in Nov. loss of 850 staff since 2008… caused by auto-reduction in income tax

Idaho New but feel connected and comfortable reaching out to others

Transition for settings; gaps in intensive supervision 1:1; struggle with dual diagnosis & how to keep setting least restrictive; EPSDT & the Autism Spectrum

Management

Look at regulations; who is driving them?

New Jersey Feel connected; uses & reads the list serve; Robin Cooper has been very helpful

30 years of reform in 3 years; moving to fee for service; supports waiver; challenges with supports coordination

Good Mix; understanding policy; positive attitude & tone; be inclusive Leadership of an organization

Maintaining a culture of support & expertise

Hawaii HI – Yes, staff extremely responsive. Didn't receive new director packet. Communicated with Karol & info was sent.

No functional electronic records system. Implementing SIS & changes in funding mechanism. Relationship with state Medicaid agency.

Ongoing strong leadership. Connecting with Governor's & their staff to educate. Connecting with NGA. Modernize, social media.

Maine Very new to position, not agency. Absolutely feels connected, extremely helpful, good relationships. Hired by Jane Gallivan.

No functional electronic records system. Implementing SIS & changes in funding mechanism. Relationship with state Medicaid agency.

Fed. Gov't presenting challenges through rule making without truly understanding programmatic impact & state by state diversity. Try to have voice at table in educating feds on realities of how rules/regs will impact programs at state level prior to changes. Also, congress. Be active in advocating with congress, more important now

83

than ever

New Hampshire Yes, feel very comfortable reaching out to NASDDDS staff.

Movement of LTSS into managed care; quality reviews

– Leveraging I/DD system expertise & working with other HCBS populations/programs, i.e. elderly & physical disabilities; the value of supporting families & what that means in terms of return on investment

Think it is very well run organization; continue to consider how NASDDDS might evolve & do things differently to meet challenges of member states

Penna. Has known Nancy so feels connected that way; otherwise, somewhat connected. Appreciates email information & listserv inquiries, & was at annual conference. Only been in position 8 months so will look to connect more.

People with complex needs/co-occurring disorders & lack of capacity in system including a rate structure to support & incentivize these supports. CMS guidance around VR services before waiver employment supports. Wanting to try innovative things but not knowing how CMS will react or facing the daunting process of getting their approval

awareness of state's best practices; responsiveness to new trends; sharing info on upcoming rule changes; creative collaborations amongst the states

loss of relevance if don't keep pace with issues important to states; potentially the dues structure if states face funding reductions

West Virginia Still learning best way to utilize NASDDDS staff, Pat Nisbet manages the I/DD waiver so is closer to the issues

challenges with providers finding staff no just in I/DD but all direct care, service industry; shift toward self-direction; rates, restructuring payment codes

said she would not be much help on this topic

30 yrs. after de-institutionalization, how do we apply lesson learned & apply to current environment including changes in technology & workforce; sustaining best practices; lawsuits; leadership at CMS

Colorado - Barb Ramsey -

She belongs to several associations & finds NASDDDS to be the most helpful. Appreciates that the group is smaller & feels very comfortable calling any of the NASDDDS staff. Liked the Director's only meetings @ the conferences.

They had a task force which developed recommendations on Conflict of Interest & the report shows that there is no consensus from the group. They are having ongoing conversations with the community center boards that a

It's important that the next Executive Director has the ability to approach issues with CMS & the administration for community living regarding concerns of how we meet difficult needs. Thinks CMS relationship is very critical. Nancy has opened the door for

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The round table discussions seem to be a more intimate dialog & enjoyed the interaction

business plan needs to be developed but there is strong resistance from the boards. They have good support from their local CMS (local CMS director) who has experience in several areas such as aging, DD, MH, etc. They are working with CMS hand in hand to come into compliance & CMS is very forthright in what needs to be done. In addition to CMS, the State Auditor's Office found them out of compliance.

positive discussions in changing culture which we are operating. I think if the next leader needs to have a wide area of experience with CMS. They must have a generous open & proactive approach in building relationships with CMS.

Continue the process where state directors come together separate & apart from the open forums. The NASDDDS business & information we receive is very helpful. Biggest challenge is implementing regulations including home like environments. Top challenges are that we need to address entire culture change related to how we will all work together from other arenas (DD, MH, Aging, etc.).

Iowa Rick Shults

In 3rd week of legislative session, difficult budget year because commitments made to education & property tax as well as we are losing FMAP @ rates by 1 ½% a year. 2016 & 2017 doesn't look as bad. Last 7 months they started operating on a regional basis (15 different regions instead of 99 counties). Local taxing authority up to a maximum limit. County joined together to form into region &

Rick is over MH & DD which includes Medicaid. They have a fast forward with CMS rule, lots of defending sheltered workshops but have a long ways to go. Good support from provider associations & think they can get into compliance within the 4 years. Not much success in downsizing private ICFs – struggling with this, have a certificate of need process, streamlining their expectations

Very happy with the support from NASDDDS. They are also happy that other areas (Medicaid - HCBS waivers) are comfortable with contact NASDDDS. Thoughts on who could replace Nancy is someone who has a good balance between positive vision for people's life & how to get there from a practical perspective. Need to know the nuts & bolts as well as how to get things

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supervisor sits on board & combines administrative structure. Initiated jointly by governor & legislator with collaboration with counties.

of the waiver. Want to come up with a creative way to get out of the ICF business. We have a large # of small ICFs & one is in the process of closing.

done, then surround themselves with those people. NASDDDS vs. other associations (Medicaid Directors) – NASDDDS does a better job & more practical information & understanding the information – more people friendly.

Missouri Valerie Huhn

Yes, she has worked with other national organizations & feels that NASDDDS is more open with communicating, emailing & phone conversations. Had relationship with Bernie prior to being Director so that was easy. Felt fine @ conference & meeting other people, feels like people have made her welcome as a new director.

Missouri is on an annual budget, Governor issued recommendations & hearings start next week. White list will be funded & having access to individuals. Working to get pay increase for providers that are paid hourly. Budget is not a challenge. Have concerns with families/providers & new HCBS rule. Have educated the providers to help with the concerns. Counties have a mil tax/property tax & they want to have a bigger stake in the game. CMS will have questions about this. John explained a little about what Ohio is doing. They have not received anything from CMS on conflict management. Counties want to get more involved in enrollment.

Impressed with NASDDDS, good with engaging & keeping everyone connected & linked with who NASDDDS has @ the top. Keep doing what they are doing. Feels like there is a lot of trust & able to communicate. Other national organizations seem to not be as open & don't feel comfortable communicating problems

North Carolina Courtney Cantrell

She has been Director for 9 month. They have not expanded Medicaid, they have a long fight just to reform Medicaid itself.

Use someone with federal experience but then not always that. Maybe a state director with experience in dealing with

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NASDDDS is very supportive compared to other associations such as putting stuff on list serve, interact with people, Barb & Nancy have been wonderful & helpful in IDD. Barb has been involved in SELN & stakeholder engagement groups, goes to dinner & always feels comfortable when asking questions. Really nice to pay a membership fee every year & then always able to ask for help, expertise, etc. when they need to. They have a very small DD team, so we have recently added more people to the team. Implemented 1915 BC waiver & now redoing service definitions, resource allocations, etc. They have 10,000 slots & 10,000 people on waiting list. Was supposed to be set up as aggregate setting but ended up with an upper limit cap, they need to add more low level slots (3000). Very happy with the resources that NASDDDS offers & the conferences.

legislator, etc. or someone who is across the country consulting & dealing with the same type of issues. Barb's experience in dealing with families & experience while in Arizona was very helpful.

Utah Paul Smith Yes, absolutely. We asked Nancy to come & meet with us for 1½ days. She did an excellent job & had a lot of great information. It gave us grounding on what we are doing right & having the ability to talk to

On an annual budget. Our immediate big crisis is anyone who wants a job, has a job. We are having problems finding direct care workers. Providers are asking if they can put individuals in institutions

Someone with experience in different sectors (private, government & regulation sides) would be valuable. If they have the skills & ability to function, communicate, how they get things done, how their minds

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someone who knows what is going on nationally & if we are on target with things. I think things are going well. Very happy with the support from NASDDDS. A lot of good information comes from NASDDDS. I also appreciate this call as it lets me know that if I need to reach out, I can do that.

because they can't find direct care staff to employ, 86% turnover rate. Providers are paid mostly a daily rate. We can't adjust rates unless legislature gives them money just for that. CMS & Conflict Management are secondary issues.

work, grasp the essentials of a policy issue, etc. could be beneficial as well. Also needs to be able manage the NASDDDS team from the different places they work & not need to micro

New Mexico Cathy Stevenson

Feels more comfortable in connecting with NASDDDS in last few years. Staff use List serve.

For the state are multiple lawsuits. Long-standing class action, & P&A & the ARC suing against reduction in services as a result of new waiver that implements service/budget limits according to individualized assessment. Want to stop implementation of the waiver. Another group that left the institution only receiving case management is being negotiated. CMS rules – trying to figure that out. State is worried about impact on state 1115 managed care program. Some challenge between Medicaid & Operating agency

Think organization has been more successful in reaching out more to the states & staying focused on families & remaining broader based. Can't be focused on limited issues as the states can't be. Have to remain broadly focused to effectively support the states.

How to remain relevant nationally & still also be relevant for the states. Remain effective in brokering role with CMS.

Arkansas Jim Brader – Acting

Former General Counsel so a long time user of ListServ & has attended attorney meetings. Feels very comfortable about reaching out.

Most challenging issues are new administration, all Rep & ran against Obamacare. Previously enacted Medicaid expansion now being held up. State Plan amendment for 1915(k) Community First Choice to address 3,000 person waiting list

Merged response to opportunities, challenges & what to preserve: a big pair of shoes to fill. When NASDDDS speaks people listen. Person needs to be smart & tough, have street credibility. Need skin in the game to be listened to by people

Would recommend his boss Dr. Charles Green for the Exec Director job.

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at risk. Waitlist a big concern & suit may be pending. Payment improvement initiative also being held up by new administration. Only 500 people in institutions & expose highlighting physical plant problems now getting appropriations moved forward by the legislation to build new institutional buildings, yet only 50 people waiting to enter the institution & 3,000 waiting for community

who need/receive services. Not just a policy wonk, need someone with personal involvement.

Michigan Lynda Zeller Yes overall feel connected Tensions between advocates & families regarding how to apply the new CMS rules; Serving adolescents & adults with autism with moderate to minimum needs as this group is not meeting the state's DD definition yet they have significant needs; Allowable alternatives to guardianship. Internal debate going on as to how to apply state laws; Current service system is a patchwork of SPAs & waivers. Getting CMS TA now. 1915(b) is having cost-effectiveness issues. Have to re-do the entire funding system. Conflict free case mngt will also come into play.

Don't always feel connected like she does with AIDD. Figuring out the aging & disability movement on the federal level. The alignment of CMS, ACL, and Justice needs to continue to be a focus.

CMS, ACL & Justice – the need for focused policy & leadership.

Illinois Kevin Casey

Travel ban but talks to Nancy about once a month. Frequent talks with staff. DD Council contract on case management.

Financial disaster area in the state. Budget has been maintained the last few years but this year could be bad. Boss

Keep providing the info states need to operate state systems. Having impacts on CMS policy is crucial & staying on top of

Replacing Nancy with the right person.

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is acting. Work to do on institutions & case management doesn't meet new rules

Congress. The CMS rules are moving in the right direction. Increase TA to states is very important

New York Texas Indiana Mississippi

All State Directors feel connected to the NASDDDS The Directors attend meetings or send staff if unable to attend Information sent from NASDDDS on program issues, list serve & publications is informative & relevant. Well connected to other Associations All State Directors feel comfortable in calling NASDDDS staff for technical assistance & guidance

New York: Transition to managed care, disallowance from ICF Billing.

Texas: Transition to MCO (Healthcare last year) 6 years to transition other services. Active litigation on PASSR at DOJ et al. Indiana: Budget issues, over haul of Vocational Behavioral, HCBS Rule, State plan for early intervention. Mississippi: DOJ-3 years to downsize facilities; add 250 waiver slots each year.

Engagement with CMST & other associations to bring information to states. Motivate each other with information. Information flow from D.C. to state to help legislators make decisions.

Not to continue relationships to CMS & other associations. Need buy-in from members.

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Summary of Reports from Board Contacts with State DD Directors

State

One thing that you hope is preserved

Top three priorities

Would you be interested in serving

Florida Barbara Palmer Michael Airs – chief of staff Lisa Robertson – strategic planning Ed – QM /behavioral services,

Connection with CMS & congressional members Ability to help states with all the questions with HCBS settings has been a good example of how essential this is for states

Learning – looking at association & priorities Communication with members More emphasis on helping states deal with fed. govt. as we try to make change. We need a strong leader to deal with congress with CMS – move outside of the work of running operations of the association (let others do that) & be a leader with decision makers

Interested - Florida has a large waiver, &it is important to be part of the work of NASDDDS.

Nebraska Jodi Fenner

Hope that whoever takes the position preserves the relationships that Nancy has &build on them. Need to have connections in the new role – need to work from relationships

Developing & grooming relationships (especially with new leaders at CMS); Staying on top of HCBS & FLSA & helping members operationalize them. Make sure big philosophical themes don't fall through cracks – still focus on family supports & person-centered practices. Collaborate with other agencies to bring in webinars on topics for directors & adm staff to keep on top of best practices &emerging issues. Managed care – how do states move forward

Jodi would love to be part of the policy work group, but would enjoy either now. She has avoided committee work because of her workload, but the time is right.

Oklahoma Joann

Continue to have director meetings with only directors, &keep focus on making public systems best they can be

Know organization – understand the source of informal &formal power. Do thorough assessment of strengths &weaknesses of association & staff

No time right now, but very interested in the information. Focus is on closing institutions right now.

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State




Get buy-in from existing staff – put energy in team developments. Not a lone ranger

Virginia – Connie Cochran

Someone who understands how systems work. There isn't one system approach, but what are the key elements to consider &make it work. Both Bob &Nancy understood this. Understand management of a network – not just "managing care"

Understand their governance within NASDDDS &is it working effectively for them – how to involve all members to feel part of the greater whole Narrow down to three deliverables that NASDDDS to member states How can we speed up time it takes states to overcome regulation - - how to have the right amount of guidelines. As you move into private sector, must strip away regulation. How to allow private sector needed flexibility to be innovative. Guidelines &regulations get in the way. People too hung up on safety, health &welfare – need more than "caring for people" to keep them safe. We are strangling ourselves &our partners. NASDDDS can really help with this…. Shape a "Do the right thing" set of policies.

Just don't have the time right now

Wyoming Chris Newman Joe &Jamie

Legacy – Nancy good at legacy of mission &sharing passion &values of org & seen as face of organization Nancy opened our eyes to national trends &helped us prepare &plan for them (workforce shortage)

Nancy personable & knows everyone. Must transition networks to the new person. Getting up to speed with legal, regulatory &other factors that impact our business States have to learn how to provider greater

Sometime in the fall, Joe Simpson would be interested in the policy committee.

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State




Expand eyes to international & world view of disabilities &how that may impact us – how do we benchmark &think about the future & what to do now Help states gain perspective &refresh with new ideas &upcoming trends Mentor coaching for new directors &transition planning. States going through lots of transitions &this type of structure &support would really help new directors or directors succession planning

oversight of waivers with less staff. Bringing guidance to government of how to create efficiencies using best of what is known in the private sector to expand how we problem solve Nancy able to bridge relationships with CMS, states, other federal departments. Must establish these key relationships with networks that feed the ability to provide early information &identify trends. Think about efficiencies & effectiveness - - how can NASDDDS keep up with technology infrastructure to keep staff &members connected & creating the virtual network.

Montana – Novelene Martin North Dakota – Tine Bay Vermont – Camille George

The amount of info that is shared is vital. Keep that up.

Communication & approachability. In terms of what is important to preserve. NASDDDS has been great in pushing policy &best practice. Good communication to the members. Any time she has reached out to a NASDDDS staff, the response has been good &timely.

Nancy has been a great resource &the communication is excellent. Especially being a somewhat new director. This communication needs to be maintained.

Willingness to be out there &help. Nancy is

The volume of information that is shared,

Help states find a balance with the new expectation of the Transition plans. Gave specifics of work expectations in balance with state budget realities &what is available. National involvement – helping navigate what is going on at the national political level

Major federal agencies. New person will have to pretty quickly get the pulse of where the individual states are. States leadership on national issues. Communication with Federal Authorities.

National Policy Work Group Novelene Martin - Interested in the Policy work group. Her background is state institution, community, &mental health. Also is the parent of the child with a disability, served on the advisory council for early intervention.

Camille George - She would be interested in policy, feels she has more to contribute to this. Travel will be an issue though. Tina Bay - Yes. She does have some concerns about time & attendance of the meeting though Research No

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State




always available &easy to get ahold of.

Communication with State Directors. Availability of staff.

Ongoing Developments. Aware of policy changes &trends. (Gave the example that NASDDDS often gives us information before we get it from elsewhere.)

Wisconsin Keep CMS informed continued advocacy for us; Keeping NASDDDS significant

Wisconsin: yes to both;;

MASS Preserve current staff… strength of the organization

Preserve staff… organization will change without skilled staff

MA no

Idaho Relationship with the states HCBS rule; new autism guidance; dual diagnosis; all states are struggling with resource allocation in an equitable way

Idaho not now;

New Jersey Feeling included Transition rule; brainstorming common problems; bring Directors together on calls to inform the political discussion &chat on common themes

NJ: Policy work group

Hawaii Network approach to technical assistance. Connecting new directors with a mentor would have been nice. More opportunities for leadership training for state staff.

Mary Brogan, definitely willing to participate, most drawn to policy

Maine Relationships with federal agencies &other associations. Maintain & strengthen partnerships.

Fostering &maintaining relationships with federal agencies &other partners. Continue producing timely &meaningful information for states, webinars, training, etc. Communicating developing issues with states

New Hampshire Maintain strong leadership approach. Parent/family member perspective &direct experience has been very valuable but that perspective must continue to be balanced with good public policy as has been the case

Relationships; strong, consistent leadership; mission, values, philosophy continue to guide organization; support NASDDDS staff

Lorene Reagan, if time commitment isn't to significant, would lean toward public policy but would hate to commit due to capacity in tiny bureau

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State




in the past

Penna. membership services & accessibility; listening to members; value for membership dues; relationships with CMS &other associations; &influence on those other organizations

Connect with members in person, phone calls, learn their issues from them; fiscal management of association; CMS relationship & attending to what is going on w/in CMS; attending to association staff

West Virginia influence on public policy &getting handle on federal temperature or "pulse"; balance between advocacy & public policy

Similar to last question, influence on public policy &getting handle on federal temperature or "pulse"; balance between advocacy & public policy

Colorado - Barb Ramsey -

Member of the NASDDDS National Policy Work Group? Current participant

Iowa Rick Shults

no

Missouri Valerie Huhn

National Policy Work Group? yes Research Committee? no

North Carolina Courtney Cantrell

Not at this time but maybe later, once fully staffed.

Utah Paul Smith Research Committee current participant

New Mexico Cathy Stevenson

The broader approach supporting families &individuals.

firmly establish federal connections; if any holes in the staff identify &fill them; have more outreach to the western states

Policy Workgroup.

Arkansas Jim Brader – Acting

Make sure states are aware of the new Exec &get face out in the field; stay on top of CMS &Labor; invaluable that NASDDDS keeps the states current.

Policy Workgroup

Michigan Lynda Zeller

Excellent communication tools-keeping people informed. TA like Robin Cooper. Strength in personality – seen as confidential yet a wise person that can be counted on yet true to members.

CMS rules; Federal policy leadership; filling Nancy's shoes.

Is a NASHP board member

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State




Illinois Kevin Casey

Preserve information systems &get it out to the states

getting to know the states &different systems &the key issues; take a close look at the what the organization is doing, where it is going &what changes should be made-encourages the Board to listen; Board needs to dedicate themselves to looking at the organization &working with the new ED.

New York Texas Indiana Mississippi

Have information from each state shared (lessons learned)

Relationship with federal partners Development &relationships with states Mesh between strategic plan &establish them with other entities.

New York to participate

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AGENDA ITEM VIII INFORMATION 2015 Directors Forum & Mid-Year Conference PRESENTER Barb Brent June 10-12, 2015 The Westin Denver Downtown 1672 Lawrence Street Denver, Colorado 2015 NASDDDS Conference Preliminary Schedule Committee Meetings Research Committee and National Policy Work Group will both be held TUESDAY evening, June 9, 2015. Directors Forum WEDNESDAY, June 10 8:30 AM – 4:30 PM (continental breakfast at 7:00 AM) Conference 8:30 AM – 4:30 PM THURSDAY, June 11 Welcome, Introductions, and Overview 8:30 AM – 9:00 AM OPENING PLENARY SESSION 8:45 AM – 10:00 AM Keynote Address Tapping the Potential in Everyone Dr. Gary Prizant, Director of Childhood Communication Services and Adjunct Professor, Center for the Study of Human Development, Brown University Gary will speak about services for children with social-communication disabilities and Autism Spectrum Disorders and their families. He will discuss his recent work on the SCERTS © curriculum; a systematic method for skill building that allows families and teams to draw from a wide range of effective practices. He will share how to build on each family's and team's current knowledge and abilities in support of a child's development. Julia Bascom, Director of Programs, ASAN June serves as Director of Programs at Autistic Self Advocacy Network (ASAN), focusing on technical assistance for self-advocates and state-level policy advocacy efforts. She also develops projects which look at standards for cognitive accessibility, the creation of independent living supports and the potential of natural supports, and ensuring meaningful, authentic, and respectful representation of the autistic and

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disability communities throughout society. Julia will provide an adult autistic perspective on services and supports provided to children with ASD and their families. PLENARY SESSION 10:15 AM – 11:15 AM Becoming Who I Am — Not What My Diagnosis Says Jeffrey J. Guenzel, Chief Executive Officer, ICDL Jeffery directs the Interdisciplinary Council on Development and Learning (ICDL), the home of DIR®, (the Developmental, Individual-differences Relationship-based approach). DIR is the foundation for understanding child development, and providing support and intervention for children. Jeffrey will describe and discuss DIRFloortime® (also known as Floortime®), an intervention for children with autism, mental health, and developmental disabilities with positive results. PLENARY SESSION 11:15 AM – 12:00 PM Collaboration and Reciprocity — The Keys to the Denver Model Aubyn Stahmer, Associate Professor, Department of Psychiatry and Behavioral Sciences, UC Mind Institute, California Aubyn Stahmer, an expert in the translation of evidence-based autism research to community-based practice and delivery, comes to the NASDDDS conference to discuss the Early Start Denver Model and how to make it possible to deliver them in settings where kids are getting usual care, in schools and early-intervention settings in the community. In partnership with families and the community, Aubyn seeks positive change. AWARD LUNCHEON Robert M. Gettings Compass Award 12:30 PM – 2:00 PM PLENARY PANEL 2:00 PM – 3:30 PM A Family for Every Child Dr. Nancy Rosenau, Executive Director, EveryChild, Inc. Dr. Rosenau is the Executive Director for EveryChild, Inc., a Texas nonprofit dedicated to supporting family life for children with I/DD creating a system of family-based alternatives to the institutions in which many currently live. With her deep interest in public policy that supports family life for all children, irrespective of how significant their support needs might be, Nancy will discuss strategies to avoid congregate care for any child. Joining her will be two state directors sharing their experiences, successes and ideas in supporting children with significant mental health needs to stay with their own families and, when this is not possible, to still live with a family. PLENARY PANEL 3:45 PM – 5:00 PM

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Home in the Key of Life — Supporting People with Significant Medical Needs in Family Homes Dianne McGinn, Program Director, Medically Complex Children's Services, MENTOR Maryland Dianne is passionate about children having the opportunity to grow up in a family home, no matter what medical needs they have and even if their parents have had their rights terminated. She will share what it takes to be successful in securing families to care for children with medical needs. Two state directors will join Dianne, sharing their state's programs and services for children with medical support needs and how services have been developed to keep children with families. WELCOME RECEPTION (with exhibitors) 5:30 PM – 7:30 PM FRIDAY, JUNE 12 PLENARY SESSION 8:30 AM – 9:15 AM Next Steps — Aspirations and Expectations in Person-Centered Planning and Self-Direction Sharon Lewis, Principal Deputy Administrator, Administration for Community Living (ACL), and HHS Senior Advisor on Disability Policy Ms. Lewis will provide insights into the expectations of both federal officials and the overall aspirations of people with I/DD and their families regarding the current system of person-centered planning and where it could and should go in the future in support of self-determination. Sharon will also provide her thoughts about the presentations from the prior day and implications for future federal and state policy. PLENARY SESSION 9:15 AM – 10:30 AM Wikis — How a Website Can Foster Self-Direction Andy Minion, Director of the Rix Centre for Innovation and Learning Disability, University of East London, United Kingdom Andy is a leader in the field of new media and social inclusion research, development and knowledge exchange. He founded the Rix Centre for Innovation and Learning Disability, with a mission to explore and develop ways in which new web and social media can be used to help improve the quality of life of people with disabilities. Andy will discuss the use of 'wikis' to foster person-centered planning and self-direction. David M. O'Hara, Ph.D., Chief Operating Officer, Westchester Institute for Human Development, UCEDD Dr. O'Hara's current research focuses on the potential of innovative information, communication, and social networking technologies to promote the participation of

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individuals and families in systems of care. With his rich background in telehealth and technology, David will join Andy Minion in presenting a new person-centered planning 'wiki'. Room Check Out, Break and Box Lunch to bring into final session PLENARY PANEL 11:00 AM – 12:45 PM Imagine Ohio Ohio Imagine is a system-wide transformation for the Ohio I/DD system, a collaboration of the Ohio Department of Developmental Disabilities, counties, and multiple partners. In a pilot phase, Imagine is a project, from training to technology, designed to break down barriers that get in the way of person-centered systems and is a common sense approach, beginning with training on person-centered thinking (PCT), and testing of tools for flexible plans. This new approach and technology will empower the person and family, as well as those in the system working to support them. A team of state, county people, and Mary Lou Bourne that have been working on Ohio Imagine will describe the project, intended outcomes and lessons learned along the way. Conference Wrap Up and Conclusion 12:45 PM – 1:00 PM

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AGENDA ITEM IX ACTION 2015 Compass Award PRESENTER Nancy Thaler

Michael W. Smull

Michael Smull has been working with state agencies since the mid-1980s. From the very beginning he understood that to have an impact on the lives of people with developmental disabilities, it was necessary to work with state service systems. His efforts have always been focused on helping organizations and systems make the needed changes in skills, practices, and policies that result in supporting people to have self-directed lives.

He has been committed to making the implementation of person-centered practices practical and doable so that systems can "go to scale."

The effort to assist states in supporting people who were challenging and needed attention to their specific needs if they were to succeed, Michael began to develop Essential Life Style Planning — a person-centered planning process developed to effectively transition individuals from institutional environments to the community.

Michael's approach to person-centered planning evolved over the years as he collaborated with others. With Helen Sanderson of the U.K. he helped to found the Learning Community — an international learning collaborative that works to further develop person-centered practices, train others and guard the integrity of the person-centered approach.

Rather than copy write publications and license tools, Michael himself and through the learning community has made all tools and publications free to the public. The resources and tools are all free to all who need them.

Michael has trained leaders, managers, and direct care workers in person-centered practices in almost all of the 50 states. Most importantly he has understood the role of support coordination and worked to strengthen their role in a person-centered system.

Michael has created a Person Centered Thinking Learning Community that recognizes the important contributions many of the facilitators make and allows for the learning to be shared among a broad group of trainers. The annual "Gathering" — a week-long meeting that is rooted in his style of learning (using a Learning Marketplace) — continues to be the epicenter of updated best practices and strategies that keeps person-centered thinking applicable across all aspects of states, providers, families, and self-advocates.

Collaboration with NASDDDS began in 1992 when Michael and Susan Burke Harrison wrote Supporting People with Severe Reputations in the Community as a NASDDDS publication.

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In 2009, Michael Smull along with his business partner Mary Lou Bourne, collaborated with NASDDDS on a federal system change grant to build person-centered practices in state agencies. Over a 5 year period, working with five state DD agencies, Michael worked with the association to train hundreds of staff in person-centered practices and to set up state systems to implement those practices. Each of those states, North Carolina, South Dakota, Tennessee, Georgia and Oregon have in place teams, person-centered coaches and capable providers implementing person-centered practices. The project resulted in two publications: Becoming a Person-Centered System - A Brief Overview and Best Practice, Expected Practice and the Challenge of Scale www.nasddds.org/resource-library/search/search&keywords=smull. Michael's work with states continues. Through his organization Support Develop Associates, he continues to collaborate with NASDDDS to support the development of person-centered practices in states.

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http://www.nasddds.org/resource-library/search/search&keywords=smull

AGENDA ITEM X DISCUSSION New Business

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AGENDA ITEM XI INFORMATION Executive Session

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NASDDDS Board of Directors Meeting · 2018. 1. 31. · (35%) by the AIDD Supporting Families grants. Those grants end in 2016, 2017 respectively. The association staff is requesting

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