Service Definitions Presented By: Robin Cooper Robin Rust 2011 Waiver Renewals Service Definitions Presented By: Robin Cooper Robin Rust

Waiver Services Individualized Supported Living Host Homes Companion Model Group Home Community Transition Employment Services Day Services Personal Assistant Transportation In Home Respite Out of Home Respite Counseling Positive Behavior Support Services Behavior Analysis- Senior Consultant Assistant Behavior Analyst Crisis Intervention

Waiver Services Personal Electronic Safety System Specialized Medical Equipment Environmental Adaptations Professional Assessment and Monitoring Occupational Therapy Physical Therapy Speech Therapy Community Specialist Communication Skills Instruction Self-Directed Options Personal Assistant Community Professional Goods and Services Support Broker Transportation

Individualized Supportive Living Individualized supports delivered in a personalized manner. Individuals live in homes of their choice: where they live, who they live with and types of community activities. No more than 4 unrelated roommates in an ISL. Owned or leased by at least one individual in the ISL. May include up to 24 hour support.

Host Home Private family home. Licensed and/or certified by the Division of DD. No more than 3 individuals with disabilities who are not related to the family. Individuals participate in family and community activities. Flat monthly rate for room and board and is exempt from income taxes.

Companion Model Person receiving services owns or rents home. Companion lives in home, room and board provided as part of their salary. Other services may be provided.

Group Home Provide care, supervision and skills training in activities of daily living, home management, and community integration. Provide to groups of recipients in group homes, residential care centers, and semi- independent living situations (clustered apartment programs). Licensed, certified, or accredited provider. Main point – We are not making any changes to this definition.

Community Transition One time set up expense for individuals who transition from congregate living to a less restrictive community living arrangement. Transition from an ICF-DD, Title XIX, Nursing home or other congregate living setting. Limited to $3,000 per person. Can we use transition services to move out of an RCF? And for waiver group homes?

Employment Services Service that assist in preparation, obtaining and maintaining employment. Job Discovery: includes volunteerism, self determination, job exploration, job shadowing, etc. Job Preparation: provide training and work experiences to teach skills necessary to succeed in paid community employment. These services are outcomes based and expected to result in employment outcomes.

Employment Service (cont’d) Community Employment: Competitive work in an integrated work setting With on-going support services. Services delivered in the community. May be one on one or groups of individuals- emphasis always on individual outcomes. On the job training in work and related skills.

Day Service Any activity that enables individuals to achieve or maintain optimal physical, emotional and intellectual functioning. May include: improvement in self-help, socialization, adaptive skills. May include assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Activities & environment are designed to foster independence and personal choice. Provided in the community or their own home, or in a day program site; individually or in small groups. Staff ratio no more than 1:6.

Personal Assistant Activities of daily living (ADL) or Instrumental activities of daily living (IADL). ADL includes: bathing, toileting, transfer, skin care, grooming, dressing, etc. IADL includes: shopping, banking, budgeting, social interaction, leisure activities, etc. 1:1 or up to 3 individuals at a time.

Transportation For individuals to access waiver and other community services, activities and resources outlined in service plan. Can be provided by an agency or an individual. Transportation not billed separately if included in ISL budget or day habilitation rate.

In-Home Respite Short term caregiver relief. Provided on a planned or unexpected basis. Service not provided in lieu of day care for children, or employment or day supports for adults. People who self-direct use personal assistant.

Out of Home Respite Care provided outside the home in a licensed, accredited or certified waiver residential facility, ICF/MR or State Habilitation Center by trained and qualified personnel. Period of no less than one day (24 hours), and no more than 60 days per year. Provide planned relief to the customary caregiver.

Counseling Not otherwise covered in State Plan. Goal oriented counseling to maximize strengths and reduce behaviors/ functional deficits which interfere with a persons life. Can be provided to individuals & families when individual is present with the family. Includes: psychological testing, initial assessment, coordinating with the family and direct counseling.

Positive Behavior Support Services (Behavior Therapy) Consultation for implementation of PBS strategies, environmental manipulations. Training to and for individuals whose undesirable behaviors disrupt progress. May include consultation for families and other caretakers. Not a long-term service. 2 tiers from PBS: Involves evaluating residential or family systems. Involves consultation, monitoring and training to establish increased opportunities for teaching and practice.

Behavior Analysis-Senior Consultant Licensed professionals (Behavior Analyst, Psychologist, LCSW, and LPC). Designed to help individuals experiencing behaviors that cause harm to self or others, or at risk of losing community participation. The service consists of design, monitoring, revision & brief implementation of 1:1 behavioral interventions. BA can also include Functional Behavior Assessment. Not a long-term service.

Assistant Behavior Analyst Must be licensed as Assistant Behavior Analyst. Managing direct implementation of recommendations and strategies of a BA. Participating in development of the BSP. Face to Face in home training on the BSP.

Crisis Intervention Definition to be refined and strategies to be developed.

Personal Electronic Safety System Electronic system that enables an individual to secure help in an emergency. Includes electronic monitoring. Cost effective alternative to paid staff and other types of supervision. Initial installation fee is covered as well as ongoing monthly rental charges, upkeep and maintenance of the devices. May be subject to rights review.

Specialized Medical Equipment and Supplies Not otherwise covered under State Plan. Includes incontinent supplies. Annual $5,000 limit per individual. Annual time period corresponds to waiver year July-June. -Address diapers.

Environmental Accessibility Adaptations Includes adaptations to home or vehicle. Annual $5,000 limit per individual. Annual time period corresponds to waiver year July-June.

Professional Assessment and Monitoring Face to face visit to evaluate need and identify appropriate assistance including any special instructions for caregivers to reduce the need for routine health professional visits and prevent a higher level of care. May include: limited physical assessments, medication set up, injections, limited diagnosis and treatment, nutritional care plans, etc.

Other Services Occupational Therapy Physical Therapy Speech Therapy Community Specialist Communication Skills Instruction

Self-Direct Support Services Personal Assistant Community Professional Goods and Services Support Broker Individual Transportation

Personal Assistant Activities of daily living (ADL) or Instrumental activities of daily living (IADL). ADL includes: bathing, toileting, transfer, skin care, grooming, dressing, etc. IADL includes: shopping, banking, budgeting, social interaction, leisure activities, etc. 1:1 or up to 3 individuals at a time.

Personal Assistant (cont’d) Team Collaboration: Allows individual’s employees to participate in service plan meetings. Also to meet as a team to ensure consistency in Service Plan implementation.

Self Directed Community Professional Qualified professional from the community. Can be paid for through budget authority; not an employee of the individual or representative. Can assist with Person Centered Planning process or other community supports. Services include: professional observation, assessment, individualized program design, and implementation. Requirements: Have a postsecondary degree or RN, and knowledge in providing support in their particular area of expertise.

Self Directed Goods & Services Service, support or good that enhances the participant’s opportunities to achieve outcomes related to living arrangement, relationship, community inclusion, work, etc. Must meet the participant’s functional, vocational, safety, medical, community membership or social needs. Must increase independence or substitute human assistance. Not available through another source or person does not have funds to purchase it. Has an annual limit of $3,000.

Self-Directed Support Broker Provides information and assistance to a individual for purpose of directing and managing services. Includes practical skills training, providing information on recruiting and hiring personal assistants. Qualifications for support broker must be at least age18, have a HS diploma or GED. Demonstrates competence of DMH and FMSP policies and procedures; understanding SB responsibilities. Can not be a parent, guardian or other family member.

Transportation For individuals to access waiver and other community services, activities and resources outlined in service plan. Can be provided by an agency or an individual.

Next Steps Work group to review/revise ISL budget guidelines. Draft services definitions posted on DD website – open for comment. Waiver applications completed by DD. Waiver applications reviewed by DSS. Submitted to CMS winter, 2010-11. Work group to review/revise ISL budget guidelines, Draft service definitions posted on DD website – open for comment Waiver applications completed by DD Waiver applications reviewed by DSS. Submitted to DMS winter 2010-11.

Questions??