NYC Family Meeting; Updates for Self-Direction

Agenda: Growth of SD Understanding the people who choose self-direction Identifying challenges and areas for improvement ASD Technical Assistance recommendations Question and Answer Session

Self Direction Updates FI fee change New Fiscal Intermediary (FI) agency in downstate region Webinars from ASD technical assistance completed in early summer

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Demographic Data

People Self-Directing Compared to Others in Traditional Services 7/12/2019 People Self-Directing Compared to Others in Traditional Services Compared those who self direct (SD) their services to those who do not self direct their services Approximately 5,000 people in SD group and 91,000 people in non-SD group Analyzed: DDP2 Health, Behavior, and Adaptive Scores Level of Functioning Age Groups

Health, Behavior, and Adaptive Score Comparisons 7/12/2019 Health, Behavior, and Adaptive Score Comparisons Overall, adaptive and health scores were similar between the SD and non-SD groups. Behavior scores were higher in the SD than in the non-SD group. Average score of 51.5 versus 39.0, respectively. Higher adaptive, health, and behavior score indicate more need

Adaptive, Behavior and Health Scores SD vs. Non-SD groups 7/12/2019 Adaptive, Behavior and Health Scores SD vs. Non-SD groups   SD Group Average Non-SD Group Adaptive Score 186.8 189.6 Behavior Score 51.5 39.0 Health Score 5.3 5.4

7/12/2019 Level of Functioning The SD and non-SD groups had similar proportions of people with mild and moderate impairment functional levels. Over twice the proportion of individuals in the SD group have normal or above functional levels compared with the non-SD group. Higher proportions of individuals in the non-SD group have severe or profound impairment functional levels compared with the SD group.

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7/12/2019 SD vs. Non-SD – Age Overall, the SD group is younger than the non-SD group. The average age of the SD group is 25 years old compared to 37 years old for the non-SD group.

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Comparison of SD and non-SD by Age group 7/12/2019 Comparison of SD and non-SD by Age group Sought to establish if differences in adaptive, behavior, and health scores, as well as level of functioning exist by age group. Compared those aged 0 to 21 and those aged 22+.

Adaptive, Behavior and Health Scores SD vs. Non-SD by Age Group 7/12/2019 Adaptive, Behavior and Health Scores SD vs. Non-SD by Age Group   Age 0-21 Age 22+ Self-Directing Average Not Self-Directing Average Adaptive Score 233.3 238.8 153.8 174.6 Behavior Score 70.7 49.4 38.2 35.8 Health Score 5.0 3.8 5.5 5.8

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What might this data be telling us? People who self-direct their services look comparable to those served in our larger system. Self-direction may offer better options for people who present behavioral challenges. Families and people who are transitioning into adult services are taking advantage of the option to self-direct their services at a higher rate.

Recommendations from Applied Self-Direction In Fall of 2016, OPWDD requested technical assistance for its Self-Direction service from the Centers for Medicaid and Medicare Services (CMS). CMS asked an experienced firm, Applied Self-Direction (ASD), to assess OPWDD’s Self-Direction program and provide recommendations for improvement. ASD reviewed extensive material, conducted multiple interviews and reflected on feedback from focus groups involving Self-Direction participants, parents, Support Brokers, Fiscal Intermediaries (FIs) and OPWDD Regional staff. ASD shared their findings and recommendations in Webinars that are available for viewing. The following information is a summary of those recommendations

Recommendations from Applied Self-Direction ASD Recommendation #1: Improvements in Support Broker Training to increase availability of support broker training and move portions of required trainings online. ASD Recommendation #2: Carefully transition away from Independent Support Brokers

Recommendations from Applied Self-Direction ASD Recommendation #3: Replace Individualized Goods and Services (IDGS) categories with a statement that Goods and Services must be directly related to the meeting the individual’s goals in the context of their disability and define what is not allowable. ASD Recommendation #4: Develop an all-encompassing service for self-hired staff, instead of using Community Habilitation, Supported Employment and Respite

Recommendations from Applied Self-Direction ASD Recommendation #5: Modify requirement for the number of Support Broker Circle of Support Meetings to be based on need, instead of four per year ASD Recommendation #6: Move final approval of Self-Direction (SD) Budgets from OPWDD Central Office to OPWDD Regional Offices

Recommendations from Applied Self-Direction ASD Recommendation #7: Move away from a 100% review of all SD plans at the Central Office level. For example, Central Office could do 10 to 25% of the reviews of Self-Direction (SD) Budgets. ASD Recommendation #8: Carefully move forward towards implementing a software solution

Activities Underway to Address Recommendations: Improved Broker training with more online training under development Streamlined approval processes Planning to implement changes that will increase Broker accountability Subcommittee proposed workgroup to look at FI consistency Implementing desk audits to review compliance/quality issues

Question and Answer Session Focus on questions submitted by participants