THE%20MRDD%20FUTURES%20COMMITTEE

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THE MRDD FUTURES COMMITTEE

• Presented to
• Disability Housing Network
• April 19, 2008

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Self Determination Recommendation 1

• Expand implementation of Self Determination
  principles for waiver and non-waiver services.
• Conduct a pilot that promotes self directed
  services, such as person-centered planning,
  individual budgeting, use of a fiscal
  intermediary/management service, and an
  independent service broker.
• Assess how to implement Self Determination
  principles services in the Home and Community
  Based Services (HCBS) waivers.
• Evaluate how to implement Self Determination
  principles for non-waiver services.

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Self Determination Recommendation 2

• Develop standards of practice around assessments
  and service planning that support the
  self-directed planning, self-determination, and
  person-centered thinking skills.
• The outcomes should be
• Family friendly
• Consistent in practice
• Streamlined using best practice

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Self Determination Recommendation 3

• Create meaningful employment opportunities for
  citizens with developmental disabilities.
• Collaborate with private and public entities to
  enhance employment options.
• Maximize incentives for employees and employers,
  such as Medicaid Buy-In, tax credits, and wage
  options.
• Find ways to make community employment the first
  option in service planning and improve
  school-to-work transition.

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Quality Legislative Mandate

• Examine the efficiency and effectiveness of the
  current system of separate and concurrent
  accreditation, licensure, certification, quality
  assurance, and quality improvement activities and
  propose changes to improve that system

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Quality Recommendation 4

• Examine training issues, complexity of
  processes, measured uniformity around processes,
  and what safety net plans exist around service
  support administration functions, with attention
  to
• Service and Support Administration functions,
  such as assessments, ISPs, service authorization,
  and provider selection.
• The SSA role at county boards, including
  requiring face-to-face contact, credentialing,
  and personal representation.
• Timely ISP development and payment authorization,
  which could include collaboration between county
  staff and providers.

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Quality Recommendation 5

• Adopt the National Core Indicators as a basis for
  measuring the performance of and improving Ohios
  MRDD delivery system.

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Quality Recommendation 6

• Explore development of a single standardized
  review tool which would apply to every type of
  provider as core qualifications. Consider
  additional standards based on the type of service
  delivered (for example, supported employment or
  residential facility).

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Quality Recommendation 7

• Immediately initiate actions to make individual
  satisfaction a more significant part of the
  quality review process.

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Quality Recommendation 8

• Revise the licensure processes for Intermediate
  Care Facilities for the Mentally Retarded (ICFMR)
  to eliminate duplication by Ohio Department of
  Health Medicaid reviews and ODMRDD licensure
  reviews.

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Quality Recommendation 9

• Adjust the mode and frequency of monitoring
  activities of HCBS waiver providers and non-ICFMR
  licensed providers so that

• Newly certified/licensed providers receive an
  on-site review within one year.
• Desk reviews and self-audits are established for
  providers who are performing well.
• New and lower-performing providers are monitored
  more frequently than established
  higher-performing providers.

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Quality Recommendation 10

• Ensure that people who provide the same service
  are subject to the same requirements, based on
  the service being provided instead of the type of
  entity providing the service.
• Except, those providers providing services to
  his/her family member(s) only and a provider who
  is self-selected and self-directed by family (for
  family members) is required only to meet
  standards similar to those for providers of
  Informal Respite.

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Quality Recommendation 11

• Establish initial requirements for all HCBS
  providers that include basic standards needed
  prior to becoming certified.
• Verify that requirements are met during the
  certification process as opposed to applicants
  simply attesting to having met the requirements,
  and include a face-to-face interview.
• Review independent providers between 6 and 12
  months of initial certification.

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QualityRecommendation 12

• Implement existing statutes that time-limit
  certification for new HCBS waiver providers.
• Develop Processes to terminate the certification
  of providers who have not billed for 12
  consecutive months.

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QualityRecommendation 13

• Consider accepting accreditation from national
  accrediting bodies (for example, Council on
  Accreditation of Rehabilitation Facilities,
  Council on Quality and Leadership, or Council on
  Accreditation) in lieu of state accreditation of
  boards and certification of providers.

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QualityRecommendation 14

• Redevelop the ODMRDD provider search website to
  assist individuals and families in identifying
  and selecting providers.

• Ensure the information is accurate and
  up-to-date.
• Include (as applicable) the most recent version
  of the providers/county boards compliance
  review, licensure survey report, accreditation
  review, Ohio Department of Health survey, annual
  MUI review, and any related plans of correction.
• Include a search tool filter to identify
  providers willing to serve additional
  individuals.

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QualityRecommendation 15

• Develop resources in a variety of formats (for
  example, informational pamphlets, checklists,
  online modules, and video conferences) to assist
  individuals and families in selecting, training,
  and monitoring providers.

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QualityRecommendation 16

• Work collaboratively to develop and implement a
  plan to increase wages, benefits, training,
  supervisory support, recruitment, and retention
  of quality direct support staff.

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QualityRecommendation 17

• Explore implementation of a competency-based
  curriculum for all providers/staff having direct
  contact with individuals receiving services.

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Specialized Needs Legislative Mandate

• Determine the feasibility and potential benefits
  of regional planning approaches to meet
  specialized and intensive service needs

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Specialized Needs Recommendation 18

• Facilitate the creation of an organized,
  system-wide network of providers of services or
  programs for populations with significant
  challenges

• Conduct regional meetings to develop regional
  partnerships and cross system collaboration and
  community planning
• Develop and disseminate training and support for
  providers, caregivers and others
• Plan for those with MRDD who are not County Board
  eligible
• Identify providers and fill in gaps

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Specialized Needs Recommendation 19

• Increase emphasis on providing age-appropriate
  services for the population of persons with MRDD
  who are over 55 years of age

• Identify the population and create an action plan
  meeting needs
• Identify or create regional solutions and model
  services or programs
• Assure reimbursement systems support integrated
  communities

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Specialized Needs Recommendation 20

• Increase emphasis on providing support for
  caregivers living with and caring for individuals
  with MRDD

• Help parents meet own needs and assure that
  childs needs can be met now and in the future
• Assist parents in transition from primary
  caregivers and support planning for the future
• Cooperate with other systems for caregiver
  support in the home
• Work with other state agencies to reduce
  complexity of support systems
• Develop a system for more flexible, reliable and
  consistent respite care

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Specialized Needs Recommendation 21

• Work collaboratively with other agencies to
  address the service needs for children ages 0-5

• Collaborate with other agencies through Child
  Find to improve identification and referral for
  EI
• Collaborate with other agencies to fund
  intensive, habilitative EI services for children
• Build on current collaborations for services
• Cooperate with other departments and schools to
  develop a plan for children ages 3-5

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Specialized Needs Recommendation 22

• Address the need for specialized services for
  individuals with very challenging behaviors

• Provide training, resources and on-going support
  for care providers, including behavior management
  and working with other systems
• Reduce medication management alone as a strategy
  for behavior control
• Increase the number of specialized behavior
  therapists and develop clinical support teams
• Create community crisis or back-up services,
  including crisis intervention, respite and
  long-term residential treatment in regional
  collaboration

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Specialized Needs Recommendation 23

• Address the need for crisis stabilization for
  individuals across age ranges, including those
  with dual diagnosis

• Create regional capacity to assess and facilitate
  community based or Developmental Center (DC)
  emergency placements that are safe for all
  residents
• Assure discharge planning for transition after
  inpatient or facility treatment
• Collaborate with other agencies, especially Ohio
  Department of Mental Health (ODMH) to expand
  access to services for the dually diagnosed
• Change DC admission criteria to allow services
  for all county board eligible persons

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Specialized Needs Recommendation 24

• Address the need for increased access to, and the
  number of, providers of medical and dental
  services with expertise working with individuals
  with MRDD across the lifespan

• Use community and regional planning to develop
  strategies to increase access to medical
  professionals
• Increase access to services using multiple
  strategies, including mobile services, delegated
  nursing, dental and medical service extenders
• Create and expand training for medical
  professionals to work with persons with MRDD

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Financing Legislative Mandates

• Review the effectiveness, efficiency, and
  sustainability of current uses of all funding
  sources for MRDD services
• Propose alternatives for effectively funding the
  non-federal share and Medicaid expenditures for
  home-and community-based services for individuals
  with MRDD
• Identify the potential for reducing
  administrative costs in the MRDD system

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Financing Legislative Mandates

• Recommend steps necessary to assure the long-term
  financial sustainability of MRDD services to meet
  current and future needs while affording counties
  the ability to make local decisions about the
  priority uses of local tax levy funding
• Propose alternatives for effectively balancing
  revenues available to county boards of MRDD to
  fulfill their responsibilities for funding,
  planning, and monitoring the delivery of locally
  administered MRDD services

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FinancingRecommendation 25

• Create data-driven analytical processes that
  align dollars toward adequate and sustainable
  funding for services and informs the Departments
  policy decisions.

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FinancingRecommendation 26

• Identify additional state and federal funds to
  support early intervention (EI) services.
• Analyze tax policies related to alcohol and
  liquor sales to consider whether the level of tax
  is commensurate with the social impact and need
  for disability-related services.

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FinancingRecommendation 27
In cooperation with the Governors Office and
Ohios Congressional representatives,
aggressively pursue federal funding programs and
prevent federal policy changes that negatively
impact people with disabilities.
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FinancingRecommendation 28
Develop a comprehensive state housing plan to
address any needed improvements to current and
future housing options to ensure the health and
safety of those individuals choosing to live in
the community.
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FinancingRecommendation 29
Design a long-term, zero-sum funding approach
that addresses financial sustainability and
predictability through risk sharing mechanisms,
as well as protect individuals access to
services. Develop a draft proposal for possible
consideration in the FY2010-2011 operating budget
deliberations. More immediately, determine
viable strategies to manage waiver reimbursement
transition costs in FY09, including realignment
of existing system resources in order to support
the rates identified in OAC.
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FinancingRecommendation 30
Ensure that the impact of losing the tangible
personal property tax on County Boards of MRDD
and other essential community services is
addressed in the next biennial budget process.
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Waiting ListsLegislative Mandate

• Evaluate the effectiveness and equity of the
  systems uses of waiting and service substitution
  lists, priority populations, and having separate
  acuity instruments that vary by service setting

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Waiting Lists Recommendation 31

• Overhaul the waiting list statute to accommodate
  the needs of individuals and families, with
  attention to
• Assessment requirement
• Identification and clarification of priority
  categories
• Reduction of the variety of waiting lists
• Consideration of statewide vs. county waiting
  lists for high cost waivers (over 100,000)

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Whats Next?

• The Recommendations will provide the framework
  for the Departments strategic plan.
• An implementation plan is being developed for all
  of the Recommendations
• The Department has begun the work to move to the
  National Core Indicators even as the
  implementation plan is being finalized