Workshop Title: State Policy Initiatives to Facilitate Individualized Supports:
Kim Rucker, Valerie Bradley, Bob Gettings, Norm Davis, Peggy Collins, Judy Wallace-Patton
VB: Self-direction grew from family support movement, personal care assistance and moving people with disabilities moving into the comminite, self-determination movement.
Basic Goal of SD: Affords people opportunity to direct funds
1. Individual budget
2. Person-centered plan
3. Supports are directed by individual
4. Responsive and appropriat quality monitoring
Community services have historically been provided through private mostly non-profit agencies.
There is a delicate balance between risk control and choice
Increase flexibility, more control
Possibility of real reciprocal relationship with staff
Isolation of provider and individual
Maintaining energy, competitiveness, competencies
Oversight of provider quality
Basic qualifications, skills and competencies
-Some level of education/age requirements
Person Centered Plan
-Identify needs for support, risks
-Determine Individual and family competencies
-Review person-specific competencies
-Determine degree of monitoring and the planning process
QA safeguard strategies
Case manager (broker) is crucial as link to traditional/professional system
Educated group of families and individuals with disabilities
Arizona has done a lot of work around safeguards including certification, background checks, licensing, core training
To do SD-
>Look at QA processes to determine which have the potential to be:
reliable and valid
2:21 Bob Gettings: State Innovations
Quality Oversight and Improvement:
Massachusetts Quality Management System: recently released a system-wide QA report that summarizes data gathered from a variety of sources and supports. The report summarizes the results of two years data. 64 measures in 12 Outcome areas: health, protection from harm, safe environments, human and civil rights, protection of rights, choice and decision-making, connections, achievement of goals, work and qualified service providers.
Other state reports/resources:
Annual Report of the Vermont Division of Developmental Services
Pennsylvania's Incident Management System
New England Quality Collaborative
Promoting Inclusinve Practices
Resource: The Community Living Eschange Collaborative (CLEC), a CMS-funded activity is hosting an interactive discussion among states around inclusion of people with disability. Changing communities rather than changing individuals to promote inclusion.
Minnesota has just gone through a process of rethinking individual budgets. New individual budgeting methodology based on characteristics of individuals to try to predict needs.
Support Brokerage and Case Management Services: Minnesota has reconsidered case-management in light of SD. Flexible case management to foster more independent choice.
2:41 Norm Davis
"The Price of Self-Determination"
Fairness & Equity, Redesign
Predictable and stable funding
Predictable and Stable Funding:
Who is "Self"
>>Circles of Support, Redefinition of family & guardian
What is "Directed"
>>Cooperative purchasing, micro-boards, cottage industry, small business development
>> Transition Savings Plans
>> Community Guides
>> Inclusion fees [?!?!?!?!]
Florida, Delaware and Montana
-Collect cost data and service and utilization data
-individual needs assessment tool
-Standarizd reimbursement rates
-Integrate self-directed services tools
Look at cashflow for providers, net wealth, sustainability
What do people buy?
Not group homes or day programs
-training and guidance
-therapies and nursing
People use similar amounts of services in very different ways
Personal cost factors (in decreaseing statistical significance)
Age and Family Situation
health and wellness
Dynamic pricing necessary
3:01 Judy Wallace-Patton and Kim:Rucker- San Diego's SD advisory committee
JW-P Brief history of the pilot projects, where they started
Each pilot used different standards for eligibility and implementation.
San Diego excluded children under age 3, random sample with subsample by age.
Substantial diversity by living situation and diagnosis
[I'm missing the next, oh, five minutes]
Challenge to make payment work.
Lesson: When we talk about quality indicators- keep them as close as possible to people and families.
KR: Experience of self-determination client
15000 consumers but 30 self-determination
Good quote:"You can have self-determination within the traditional system."
Recognizing that self-determination is primarily an internal condition with an outlook.
"You have to have a way of thinking that is within your budget and outside the box:
[Lightbulb moment- Norman Kunc and Kim are both saying that the adaptive, problem-solving skills that people with diasbilities have are the reason self-determination can be more efficient than the traditional system which is directed by non-disabled people.]
"Ask us what we think is best for us. We can let you in or keep you out."
3:20 Peggy Collins:
What's happening in Sacramento vis-a-vis non-traditional services
California finally has an Olmsted advisory process.- Chesbro agreed to stay in the process as long as its moving forward.
Olmsted presents an opportunity to focus across systems, across people.
Olmsted can move faster than state departments, evolve faster.
Lynn Daucher has a bill to require meaningful transition planning
Chesbro will introduce a bill.
DDS is where the big ticket items are
Agnews closure is huge, 10 years after the previous Camarillo
Building community infrastructure, new models are being developed to move people from DCs into homes, not ICF's.
Slef-directed services- worry about the fast growth. Initially legislature was careful that the initial Regional Centers believed in it. Now it will be involving RCs that don't embrace the concept and will alarm stakeholders who are more comfortable with the old way.
Rate standardization. We (the legislature) don't know what that means. Match expectations with what we are paying people.
Quality Management is important, to measure programs against outcomes. Hopefully not creating a QM system that is overly bureaucratic and punitive.
POS standards are now "common-sense cost containment strategies" Prospects dim in legislature.
Legislature is interested in feedback on how FCAP is going.
In other departments-
DHS Medi-Cal reform, very important for DD system although we are not always at the table. Expanding mandatory managed care. May be good for the general Medi-Cal population but concerning for people who need specialists.
IHSS reduction could be devastating for DD clients.
Deparment of Mental Health: What would happen if there was money in system to do real planning, intervention and development of improved system. $800 million averaged over five years. Statewide commission. Many DDS clients are also MH-involved. Chance to see how well this can work, shifting control out of Sacramento and into local hands. Very exciting (Prop 63). Look at changes in MH for good systems.
There are more innovative options on the table than there have been in a long time. It can all go South, so its scary. sen.ca.gov track legislation, agendas, etc. Public Hearings will begin soon. Lots of'em.
"Change is inevitable. We can control what it looks like if we use our voices."
3:43 Q & A
Q: Is there any information or studies around how to create quality incentives?
VB: Expansion of concern about competency of direct support professionals. Competency-based certificates in Ohio and Kansas. Use of "portfolio" rather than education. UMinn- college of direct support, on-line curriculum for direct-care staff.
Quality Mall- a resource for person-centered support.