Orange County ARC Open Forum

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Orange County ARC Open Forum

• An Open Forum on Self Directed Services, SB 1270,
  The 06-07 Budget Act for Wage Enhancements, and
  the Future of Community Support Services
• Shirley Dove, President and
• Tony Anderson, Executive Director
• The Arc of California November 15, 2006

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Overview

• Self Directed Services
• Senate Bill 1270
• The Budget Act 06-07 19.1 ML Wage Pass-Through
• The Future Trends and Ideas

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SELF-DIRECTED SERVICES PROGRAM

• Provided By
• The California Department of Developmental
  Services

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Topics

• Background
• What Does the Self-Directed Services Program
  Provide?
• Self-Directed Services Principles
• Pilot Projects
• Independence Plus Waiver
• Program Eligibility
• Enrollment Criteria

• Program Design
• Person-Centered Planning
• Individual Program Plan
• Training Information Supports
• Individual Budget
• Type of Services
• Risk Pool
• Services Guideline
• Supports Brokerage Services
• Financial Management Services
• Regional Center Services
• Participant Protections
• Quality Assurance and Improvement
• More Information

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Self-Directed Services Principles

• Self-Directed (SD) Services is guided by the
  vision that
• people with disabilities will determine their own
  futures,
• with the support of families, friends, and
  professionals.
• Based on five principles
• Freedom
• Authority
• Support
• Responsibility
• Confirmation

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Self-Directed Services Principles

• Freedom
• Ability for individuals to plan a life and
  customize the purchase of needed resource and
  services.
• Authority
• The ability to control a certain sum of dollars
  in order to purchase necessary supports.

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Self-Directed Services Principles

• Support
• The arranging of resources and personnel-both
  formal and informal that will assist an
  individual with a disability to reside within the
  community.
• Responsibility
• To accept a valued role in the community and to
  be accountable for spending public dollars that
  are life enhancing.
• Confirmation
• To recognize the importance of leadership of
  self-advocates in the SD Services Program.

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Pilot Projects

• The California Department of Developmental
  Services
• (DDS) has five Self-Determination pilot projects

• Tri-Counties Regional Center and Area Board IX
• Eastern Los Angeles Regional Center and Area
  Board X
• Redwood Coast Regional Center and Area Board I
• Kern Regional Center and Area Board XII
• San Diego Regional Center and Area Board XIII
• January 1, 2006, DDS is providing a new program
  that will be called Self-Directed (SD) Services.

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Pilot Projects

• Program success as reported by pilot
• participants
• Improved relationship with family members.
• More positive interactions with other people.
• Increased involvement and interaction in their
  community.
• High consumer satisfaction.
• Families and participants are responsible
  stewards of public funds.

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Independence Plus Waiver

• DDS will offer SD Services contingent on the
  approval of a federal waiver the 1915c
  Independence Plus (IP) Waiver.
• This IP Waiver is the federally funded
  Self-Directed Waiver of the Self-Directed
  Services Program.
• CMS developed the IP Waiver templates for states
  offering SD Services and seeking federal fund
  participation (FFP).

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Independence Plus Waiver
DHS Review and Approval
Regional Center Training And Education
Program Implementation And Participant Enrollment
CMS Review and Approval
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Program Eligibility

• Individuals do not have to meet Medi-Cal
  eligibility and level of care requirements in
  order to participate in the SD program. The
  program will include both state general fund and
  federal funding.
• Everyone has access to the same services and all
  services can be billed to the SD Waiver.
• General funds will be available for individuals
  who are not SD Waiver eligible.

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Enrollment Criteria

• Be a regional center client
• Not reside in a licensed residential services
  facility
• Receive services in non-congregate settings only

• Be age 3 or older
• Must volunteer to participate
• Willing to live within the individual budget
  amount

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Enrollment Criteria

• Willing to

• Accept the individual budget amount.
• Employ or designate a Financial Management
  Services entity.
• Employ or designate an individual to provide
  Supports Brokerage Services.

• Attend an in-depth orientation to the SD Services
  Program.
• Agree to purchase services within the SD Program.

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Person-Centered Planning

• The Person-Centered Planning process will drive
  the development of the Individual Program Plan.
• The participant will direct the PCP process, with
  support from the Supports Broker, a regional
  center representative, and PCP Team (made up of
  family, friends and professionals).

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Individual Program Plan

• An IPP review will be done every twelve months
  (minimum) or whenever there is significant change
  in the persons life circumstances, and must be
  agreed upon by the participant and the Service
  Coordinator.
• Details the needs, preferences, and hopes and
  dreams of the individual.
• Includes WHO does WHAT by WHEN.
• Specifies the amount of the Individual Budget.

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Participant Training and Information Supports

• Individuals who join the SD Services Program will
  receive an orientation and training that will
  include
• Training on the values, principles, and
  philosophy of SD Services.
• Employer training, hiring, supervising, managing,
  and evaluating service providers.
• Other training includes mandatory and special
  incident reporting, legal rights, and
  self-advocacy.

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Regional Centers Training and Information
Supports

• Training will be available to regional
• centers regarding
• Values, principles, and philosophy of SD Services
• Allowable Services
• Development of Individual Budget
• Regulatory requirements

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Individual Budget

• Each participant will have an individual budget
  to purchase services and supports to meet the
  goals and objectives in his/her IPP.
• Defines a set amount of money available.
• Is based on a fair and equitable process that
  takes into account individual functional skills,
  demographic characteristics, and needs.
• Based on average costs of regional center
  consumers with like characteristics and needs.

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Type of Services

• Flexibility to move money within service
  categories in the budget.

• Community Living
• Respite Services
• Support Brokerage
• Financial Management Services Bill payer
• Financial Management Services Employer of
  Record
• Family Assistance and Support
• Housing Access Supports
• Community Living Supports
• Advocacy Services
• Participant-Designed Goods and Services

• Health and Clinical Services
• Home Health Aide Services
• Skilled Nursing
• Integrative Therapies
• Communication Support
• Crisis Intervention
• Nutritional Consultation
• Behavior Intervention Services
• Specialized Therapeutic Services
• Specialized Medical Equipment and Supplies

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Type of Services

• Employment
• Supported Employment
• Pre-Vocational Services
• Training and Education
• Individual Training and Education
• Training and Education Transition Service

• Environmental and Medical Support
• Environmental Accessibility Adaptations
• Personal Emergency Response Systems
• Transportation
• Transportation
• Vehicle Adaptations

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Risk Pool for Unanticipated Needs

• 5 of the purchase of service funds appropriated
  for the SD Services program go to the risk pool.
• Funds can be used for unanticipated needs.

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Services Guidelines

• Non-congregate settings.
• Participant directed.
• Use natural supports and generic services first.
• Fit SD Services Program definitions.
• Service providers meet qualifications.

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Supports Brokerage Services

• A participant must hire or designate a
• Supports Broker of his/her choice.
• Supports Broker may
• Assist the participant to define his/her needs in
  preparation for the PCP process.
• Identify, coordinate, and access generic
  resources.
• Assist with soliciting customized and
  cost-effective services.

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Supports Brokerage Services

• Supports Broker may also
• Assist participant to negotiate rates and to
  arrange contracts for services.
• Contribute to the evaluation of the effectiveness
  of services and supports.
• Participants can obtain a list of trained
  supports
• brokers from his/her regional center.

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Financial Management Services

• Each participant must hire or designate
• Financial Management Services (FMS) of
• his/her choice.
• A FMS may
• Provide payroll and bill payment benefits
  administration, tax deductions, and record
  keeping.
• Ensure that service providers meet requirements
  and complete paperwork.

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Financial Management Services

• An FMS
• Initiates criminal background checks, at no cost
  to the participant.
• Assists the participant to understand billing and
  employer responsibilities.
• Prepares a monthly budget statement for the
  participant and the regional center service
  coordinator.
• Identifies budget categories that are over or
  under budget.

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Regional Center Services

• The Regional Center will
• Provide SD Services informational meetings to
  potential participants.
• Conduct required orientation for new enrollees.
• Ensure completion of the SD Services Program
  eligibility determination and participant
  agreement.
• Set the foundation for quality services by
  ensuring that the IPP addresses participants
  identified needs.

• Participate and complete the IPP and Individual
  Budget.
• Monitor IPP implementation and participant
  satisfaction.
• Provide services in risk and safety management,
  technical assistance, and training.

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Regional Center Services
The Regional Center will be responsible for these
risk management activities

• Follow-up special incidents involving the
  participant, including suspected abuse, neglect,
  and exploitation.
• Respond to participant complaints.

• Assist the participant to access regional center
  clinical teams when necessary.
• Maintain a 24-hour emergency call line for
  reporting of suspected abuse/neglect.

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Participant Protections

• Participant risk and safety considerations,
  including potential interventions, will be
  identified in the IPP.
• Emergency back-up plan specified in the IPP.
• IPP modified, as needed, in the event of a
  critical incident or life endangering situation.
• Safeguards through monitoring activities of the
  participants individual budget.
• Provide for fingerprints and criminal background
  checks as requested by the participant.

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Quality Assurance and Improvement

• Includes discovery, remediation, and quality
  improvement features.
• Verification of provider qualification.
• Participant review/approval of provider invoices.

• Necessary participant protections to assure
  health and well-being.
• Monitoring of quality of service and
  participation satisfaction.
• Establishes local and statewide Self-Directed
  Waiver Quality Improvement Teams.

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More Information

• An Individual can get more information about the
  SD Services Program by visiting the DDS website
  at
• www.dds.ca.gov

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Senate Bill 1270 by Senator Wesley Chesbro

• Sponsored By
• The California State Council on Developmental
  Disabilities

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The Logic

• Most consumers participate in traditionally
  structured habilitation, work activity, and
  supported work programs.
• These programs may not provide the flexibility,
  community integration, and activities or training
  that meet the needs of some persons with
  developmental disabilities.
• Therefore SB 1270 aims to improve options and
  choices of persons with developmental
  disabilities in determining their daily
  activities(and) to explore mechanisms for
  developing and expanding the methods of providing
  the services and supports

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Training for Regional Center Case Managers

• Assess the need and develop a plan for the
  training of regional center staff on employment
  issues faced by persons with a developmental
  disability.

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Informed Choice

• Requires regional centers to provide information
  relevant to individuals with developmental
  disabilities in making informed choices about
  employment.

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The Developmental Disabilities Program
Development Fund

• The Fund shall provide resources needed to
  initiate new programs and to expand or convert
  existing programs.
• The fund shall promote services and supports that
  increase opportunities for self-determination and
  independence.

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State Council on Developmental Disabilities

• Requires SCDD to convene a workgroup that will
  develop alternative and expanded options for
  nonresidential services and supports.
• The workgroup will develop and submit their
  recommendation to the Governor and appropriate
  committees of the Legislature by May 1, 2007, and
  include these in the state plan.

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Workgroups Stakeholder Groups

• The workgroup shall include people with
  developmental disabilities, family members,
  providers, and other system stakeholders and
  shall develop recommendations on how to best
  achieve all of the following
• More models that provide an array of
  nonresidential options for participation in
  integrated instructive, social, civic, volunteer,
  and recreational activities.
• More work activities for customized employment,
  integrated job training, and employer-provided
  job coaching.
• More work opportunities in the public sector.

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Workgroups Stakeholder Groups - continued

• The increased utilization of existing models,
  including, but not limited to, self-directed
  services, vouchers, family teaching models,
  existing habilitation, and supported work vendors
  to facilitate access to nontraditional
  community-based nonresidential activities.
• Strategies to promote and duplicate successful
  and innovative models developed in California and
  in other states.
• The identification of, and strategies to address,
  statutory, regulatory, licensing, vendor-related,
  funding and other types of barriers to achieving
  the goals identified in this act, including
  strategies to improve individualization of
  services and supports by increased flexibility in
  design, staffing, and compensation.

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Regional Center Responsibilities

• Outreach to, and training and education of,
  community service agencies and programs,
  businesses, and community activity providers to
  expand opportunities for participation by
  consumers.
• Develop a community resources list.
• Provide help to case managers and family members
  on expanding community integration options in the
  areas of work, recreation, social, community
  service, education, and public services.

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Regional Center Responsibilities - continued

• Developing and facilitating the use of innovative
  methods of contracting with community members to
  provide support in natural environments to
  regional center consumers.
• Development and facilitating the use of natural
  supports to enhance community participation.
• Providing technical assistance to, and
  coordinating with, community support facilitators
  who will be used to provide supports to
  individual consumers for community participation,
  as needed.

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Regional Center Responsibilities - continued

• Providing sources of information relevant to
  individuals in making informed choices about
  employment options.
• work incentive programs for persons with
  developmental disabilities,
• access and retention of needed benefits,
• interactions of earned income, asset building, or
  other financial changes on benefits,
• employment programs and protections,
• taxpayer requirements and responsibilities,
• training opportunities,
• and information and services available through
  other agencies, organizations, or on the
  Internet.

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19.1 Million Wage Enhancement

• Provided By
• The Budget Act 06-07

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The Budget Act 06-07 19.1 Million Wage
Enhancement

• Wage enhance for direct support professionals in
  work activity programs, day programs, and
  look-alike programs when any of the following
  criteria are met
• The majority of its services and supports are in
  integrated community settings .
• In the process of converting to integrated
  community settings.
• The work activity program is in the process of
  converting to supported work programs.

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Types of Eligible Services

• Socialization Training Program
• Behavior Intervention Training
• Community Integration Training Program
• Community Activities Support Services
• Mobile Day Program
• Creative Art Program
• Adaptive Skills Trainer
• Independent Living Specialist
• Activity Center
• Adult Development Center
• Behavior Management
• Independent Living
• Social Recreation
• Infant Development Program
• Work Activity Program

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Self-Certify to One of the Following

• Consumers spend and will continue to spend 51 or
  greater of the program day in integrated
  community settings.
• Provisional Rate Increase By June 30, 2008,
  consumers will spend and plan to continue to
  spend 51 or greater in integrated community
  settings.
• A work activity program providing a majority of
  their services and supports in integrated
  community settings is defined as having
  transitioned 51 of the consumers
• Calculation of consumer participation in
  community activities is calculated for the
  aggregate of consumers served in each program. In
  the aggregate the consumers must participate 51
  of the program day in community-based activities.

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Provisional rate increase A WAP must agree to
complete all the following

• Transition 10 of the consumers served into a
  supported employment program by December 11, 2007
  with a commensurate 10 net reduction in census.
• Develop a plan with the regional center and
  submit the plan to the Department by June 30,
  2007.
• The plan must specify a timeline and process for
  achieving 51 net reduction.
• To maintain eligibility the work activity program
  must demonstrate conformity to the timeline of
  this plan each year the plan is in effect.

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Thoughts on the Future of Community Services

• Provided By
• The Arc of California

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The Future of Services Supports

• Developmental Centers continue to close and
  non-forensic needs continue to decline.
• Money Follows the Person and Self Directed
  Waivers national trend.
• Historic low tax revenue Historic High Deficit.
• The Graying of the Nation and the increasing need
  for direct support services.
• Chapters of The Arc continue to diversify
  nationally no growth in Sheltered Workshops (SW)
  in CA.
• Some CA chapters have closed SW altogether.
• Supported Employment, Family Home model,
  Supported or Independent Living service trends.

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The Future of Services Supports Advocacy
Stakeholder Ideas

• Investing in outcomes - not process - in the
  lives of people with developmental disabilities
• Investing in the community
• Seeking continuous improvement of operating
  efficiencies at all levels of the system
• Promoting increasing federal financial
  participation
• Investing in wages and benefits for direct care
  workers

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The Future of Services Supports Advocacy
Stakeholder Ideas

• Investing in service models that are state of the
  art, forward looking and produce favorable
  measurable outcomes that support
  inclusion/meaningful participation in the
  community for people with developmental
  disabilities
• Improving existing community infrastructure
• Strengthening families to provide supports
• Strengthening self advocacy and responsibility
  among people with developmental disabilities and
• Educating people to utilize and manage benefits
  from all available sources.

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The Arc of California

• Core Values People First, Democracy, Visionary
  Leadership, Community Participation, Diversity,
  Integrity and Excellence.
• Preserve the Entitlement It is not ours to give
  away.
• Protect the Person-Centered IPP The individual
  plans drive the service system not the other way
  around.
• Do everything you can to improve the quality and
  stability of the workforce and support family
  caregivers without this people will end up back
  in institutions.
• Wake-up the sleeping giant grassroots family
  advocates and self-advocates should drive the
  system changes.