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John L. Martin, Director Ohio Department of MRDD
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• The Mission of the ODMRDD is continuous
  improvement of the quality of life for Ohios
  citizens with developmental disabilities and
  their families

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• Less complex services, with fair and logical
  payment systems
• Good stewardship of limited resources
• Quality outcomes through a combination of people
  and processes
• Service delivery models designed in response to
  choices made by the people served, in alliance
  with community supports
• A system-wide vision developed with stakeholders

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ODMRDD STATE OF THE STATE
OHIOS BUDGET SITUATION

• Recently, a 540 million state budget adjustment
  was announced
• Implemented with a 4.75 across-the-board
  reduction for all state agencies
• Reduction is in addition to the 733 million
  budget adjustment plan announced in January,
  making a total of 1.27 billion in budget
  adjustments over the biennium

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ODMRDD STATE OF THE STATE
OHIOS BUDGET SITUATION

• 198 million will come from agency reductions
• The remaining 342 million will be made up
  through a variety of cash management actions
• Situation presents challenging environment for
  Ohio
• The ODMRDD Leadership Team is mindful of and
  sensitive to the impact that the required budget
  changes will have on Ohios MRDD community

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ODMRDD STATE OF THE STATE
OHIOS BUDGET SITUATION

• First phase was absorbed by Central Office
  Administration, as well as by a reduction to
  increased funds slated for protection services,
  and adjusting the census at Developmental
  Centers.
• For this second phase of reductions, it will be
  necessary to again look at the Central Office
  Administration, as well as make further reduction
  to protective services. Unlike the first round of
  cuts, this round will significantly affect county
  subsidies.

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ODMRDD STATE OF THE STATE
OHIOS BUDGET SITUATION

• At ODMRDD, this means a reduction of
  approximately 16.9 million.
• The approximate figures for the areas affected
  are
• Central Office Administration - 273,555
• Protective Services A reduction of 127,595
• Residential and Support Services A reduction of
  554,642
• Family Support Services A reduction of 624,501
• County Board Subsidies A reduction of
  14,059,796
• Tax Equity A reduction of 1,260,000

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ODMRDD STATE OF THE STATE
OHIOS BUDGET SITUATION

• During the last biennial budget ODMRDD had to cut
  17 million in General Revenue Fund
• We anticipated the financial situation ahead of
  time and began to talk with stakeholders,
  Governor Strickland and the General Assembly to
  prepare
• Out of these discussion, the MRDD community came
  together to create the Futures Committee

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• The Committee was charged with reviewing the
  state's MRDD system and focused on four themes
• Accessing Services and Supports
• Financing
• Delivering Quality Services
• Serving Populations with Specialized Needs

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• Committee members, representing diverse roles and
  perspectives across the MRDD community, came
  together to adopt 31 recommendations.
• These recommendations emphasized involvement of
  individuals and families in directing services
  and defining quality of services.

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In March 2008, the Committee delivered its
final report to Governor Strickland and the
General Assembly. This report set forth positive
steps to improve services, processes, and
supports for individuals and families.
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• To implement the Committees recommendations,
  ODMRDD established six internal project teams
  outlined work steps, objectives, and products
  and developed initial timelines for outcomes and
  products.

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• Access and Care Management
• Patrick Stephan - Lead
• Waiting Lists
• Individual Service Planning
• Service and Support Administration
• Delivery System Management
• Kate Haller - Lead
• Quality
• Planning Capacity
• Developing Capacity

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• Empowering People
• Lisa Walsh - Lead
• Choice
• Control
• Family Support
• Services Management
• Michael Rench - Lead
• Covered Services
• Service Packages Design

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• Strategic Implementation
• Becky Phillips - Lead
• Policy
• Strategy
• Decision Support
• Ann Rengert - Lead
• Data/Fiscal/Legal Analysis

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• ODMRDD released the first phase of
  deliverables (products) related to the 31
  recommendations of the MRDD Futures Committee on
  August 6.

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The work completed in Phase One, which
includes 17 deliverables, is available at the
Futures website http//mrdd.ohio.gov/futures/
Draft documents are presented for the entire
MRDD community to review and provide feedback via
e-mail to futures-feedback_at_odmrdd.state.oh.us
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• Empowering individuals, families local
  communities to have the information and tools
  necessary to decide how best to move forward
• Working together to develop ways to be better
  prepared for the future through data-driven
  analysis
• Developing long-term funding approaches that
  address sustainability and determining viable
  strategies to protect individuals access to
  services

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The biennial budget strategy for Fiscal Years
2010 and 2011, including identification of
necessary revisions to the Ohio Revised Code, has
been developed in collaboration with system
stakeholders.
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• We are working to protect individuals and
  families who receive services from being impacted
  by
• - offsetting some subsidy reductions with
  replacement revenue
• - reducing administrative burdens and thereby
  helping county boards and providers to reduce
  their administrative costs
• - piloting some regional projects and
• - increasing the number of people receiving
  services by
• implementing a new flexible supports waiver.

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ODMRDD FUTURESDELIVERABLE 1

• We are implementing the recommendations of the
  MRDD Futures Committee during a time when
  resources are scarce.
• ODMRDD submitted the budget to the Office of
  Budget and Management on September 15, 2008.

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3.9 Billion Annual Tax Relief From Long-Term
Reforms (FY 2010)
Ohio Department of Taxation
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The concept for a new flexible support waiver
has been developed and documented.
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• The waiver will provide flexible options to
  support children with intensive needs living in
  the family home.
• ODMRDD is sharing the waiver proposal with
  stakeholders for review and comment.
• ODMRDD will collaborate with the Ohio Department
  of Mental Health and the Ohio Department of Job
  and Family Services to develop waiver template
  for submission to the Centers for Medicare and
  Medicaid Services (CMS) in late 2008.

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A strategy including the use of multi-media
materials to assist individuals and families in
understanding, accessing, and navigating the
service delivery system has been developed and
disseminated.
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• Existing materials were inventoried and
  out-of-date materials will be revised.
• ODMRDD is working with the Ohio Legal Rights
  Service, The Arc, county boards of MRDD, and
  others to improve information sharing and
  availability of materials to individuals and
  families in a variety of formats.
• An audio-visual tour of the ODMRDD website,
  designed to take users through the site
  step-by-step, has been developed.
• Family Chat, a discussion listserv for families,
  is being pilot tested.

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An analysis of the existing provider search
website has been conducted to identify potential
short-term refinements.
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• ODMRDD has created a list of recommended actions
  including a status/tracking mechanism.
• A review of proposed enhancements is underway to
  determine additional functionality options and
  opportunities for future versions of the website.
• The website has been updated to improve
  visibility of information on various monitors and
  screens.

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A regional model to support young adults to
successfully transition from school to work has
been developed to be pilot-tested.
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• ODMRDD is securing additional funding totaling
  500,000 from the Ohio Department of Job and
  Family Services through a Medicaid Infrastructure
  Grant beginning in 2009.
• A model school-to-work transition program will be
  piloted in a region and then be available for
  statewide implementation.

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An analysis has been completed to determine
how Atlantes health care management software
aligns with individual service planning needs in
the MRDD system.
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• ODMRDD previewed the Atlantes system to determine
  if it would meet needs such as the on-line
  Individual Service Plan and assessment processes
  and support improved case management, care
  coordination, and service to individuals and
  families.
• ODMRDD staff will work with staff of the Ohio
  Department of Job and Family Services to identify
  additional questions and issues related to
  Atlantes and how it will be used by Ohio.

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A standardized, on-line individual service
plan (ISP) format has been developed to be
pilot-tested.
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• A draft ISP form has been developed.
• Based on the feedback, ODMRDD will identify
  crucial ISP elements and potential alternatives
  to adoption of the ISP template.

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A statewide strategy to revise and better
manage waiting lists has been developed.
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• The strategy shifts from current process of
  waiver allocation first, service needs second to
  new paradigm service needs first, delivery
  options second.
• Calls for one waiting list based on services
  needs.
• Requires modification to the Individual
  Information Form (IIF) system to collect concrete
  data about individuals service needs.
• Priority categories and their role in service
  delivery need further definition and refinement.

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A model for regional planning and
partnerships, including a framework for
development of county boards' annual strategic
plans that requires meaningful participation of
individuals and families has been developed and
necessary revisions to the Ohio Revised Code have
been identified.
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• ODMRDD has developed a template and instructions
  to guide county board strategic plan submission
  (with options for regional partnerships built
  into template).
• Individuals and families who receive services
  will approve plans.
• County level plans will roll up into regional
  and state plans.

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Materials that support care providers and
promote the Behavior Support Advisory Councils
Positive Intervention Culture have been
developed.
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• The elimination of aversive interventions is a
  key factor in ensuring that individuals
  experience a quality of life that is in line with
  the Positive Intervention Culture
• A draft Information Notice regarding the Positive
  Intervention Culture has been developed.
• Additional materials, including data collection
  instruments and the Crisis Intervention Program
  Assessment Tool, will be shared with stakeholders
  after the Information Notice has been finalized.

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A statewide housing survey has been initiated.
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• Through two initiatives, groundwork is being laid
  for a statewide housing plan to be developed by
  the Governor's Interagency Council on
  Homelessness and Affordable Housing.
• The Technical Assistance Collaborative (TAC) was
  selected to review and analyze housing resources.
  County Boards will be equipped to create housing
  plans for citizens that integrate with the
  statewide plan.
• ODMRDD will participate on the Council and
  provide logistical support to TAC throughout the
  project.

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The National Core Indicators have been
implemented.
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• The Center for Marketing and Opinion Research has
  been selected to conduct individual and family
  surveys.
• ODMRDD will be able to measure system
  performance, compare data with other states, and
  make improvements that better support individuals
  with disabilities and their families

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Methods for measuring individual satisfaction
have been analyzed and a plan for incorporation
into the quality review process has been
developed.
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• ODMRDD has selected the Participant Experience
  Survey as the tool to gather information from
  individuals receiving services as part of the
  quality review process.
• This survey tool provides indicators in the areas
  of Choice and Control, Respect/Dignity, Access to
  Care, and Community Integration/Inclusion.
• The Survey will be incorporated into the quality
  review process for individuals receiving HCBS
  waiver services.

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A draft administrative rule for provider
certification that implements time-limited
certification and application fees has been
developed and disseminated for review.
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• A draft rule and supporting procedures have been
  developed.
• The rule calls for direct services workers and
  chief executive officers of agency providers to
  meet basic requirements and requires most direct
  services workers to hold valid certification in
  first aid and CPR and to complete training prior
  to obtaining certification.
• Existing providers will be notified that their
  certification will expire and will need to
  reapply to renew.

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Duplication between ODMRDD licensure and Ohio
Department of Health (ODH) certification for
Intermediate Care Facilities for the Mentally
Retarded has been identified.
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• An analysis of ODMRDD licensure and ODH
  certification has been conducted.
• ODMRDD intends to reduce the amount of time spent
  on-site by enabling providers to submit
  documentation prior to the review.
• The on-site review will focus more specifically
  on quality indicators and performance that must
  be verified by visual observation.

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Requirements to update training curriculum and
develop a new course regarding specialized
service needs have been specified in the Fiscal
Year 2009 contract with the Ohio Alliance of
Direct Support Professionals.
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• A course on Autism and Behavioral Supports is
  being developed.
• ODMRDD will continue to facilitate partnership
  between the Ohio Alliance of Direct Support
  Professionals and the Ohio Center for Autism and
  Low Incidence.

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Framework has been outlined for state
accreditation, licensure, and provider compliance
which meets the Centers for Medicare and Medicaid
Services (CMS) requirements, focuses on outcomes,
and promotes best practices.
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• ODMRDD staff are designing a single standardized
  review tool that will apply to every type of
  provider.

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The work completed in Phase One, which
includes 17 deliverables, is available at the
Futures website http//mrdd.ohio.gov/futures/
Draft documents are presented for the entire
MRDD community to review and provide feedback via
e-mail to futures-feedback_at_odmrdd.state.oh.us
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John L. Martin, Director Ohio Department of
MRDD Phone [phone] Fax (614)
644-5013 Email John.Martin_at_dmr.state.oh.us