Joint Finance Committee Hearing Delaware Health and Social Services Department of Health and Social Services Division of Developmental Disabilities Services Joint Finance Committee Hearing Fiscal Year 2016 Jane J. Gallivan Division Director March 26, 2015 Good morning Representative Smith, Senator McDowell, members of the Joint Finance Committee, and honored guests. I am Jane Gallivan, Director of the Division of Developmental Disabilities Services. Also with me today are Marie Nonnenmacher, Deputy Director of the division, Frann Anderson, DDDS Director of Quality Improvement and Dr. Terence Macy, the new Director of DDDS Community Services Delaware Health and Social Services DDDS FY 16 JFC Presentation - March 2015

Delaware Health and Social Services Vision Valuing persons with intellectual and developmental disabilities, honoring abilities, respecting choice, achieving possibilities.....working together to support healthy, safe and fulfilling lives At DDDS, our vision is: “Valuing persons with intellectual and developmental disabilities, honoring abilities, respecting choice, achieving possibilities..... working together to support healthy, safe and fulfilling lives.” Delaware Health and Social Services 2 DDDS FY 16 JFC Presentation - March 2015

Individuals Served by DDDS Intellectual Disabilities Autism Spectrum Disorder Prader Willi Syndrome The Division of Developmental Disabilities Services (DDDS) is responsible for serving Delawareans with intellectual disabilities, autism, and related developmental disabilities. A developmental disability is a lifelong condition. Our challenge is to design a system of supports and services that will be flexible and responsive to meet the needs of all individuals as they change over time. DDDS FY 16 JFC Presentation - March 2015

DDDS Population by Service Settings As of the December 2014 DDDS census report, the Division provides services to 4,028 individuals and their families. Of these, 2,869 individuals, or over 70%, live at home with their families, 1,037 receive residential services in the community and 122 individuals reside either at Stockley Center or in nursing facilities. Over 97% of the Division’s clients live in a community-based setting. The majority of funding for recipients of DDDS services is paid out of the Medicaid budget, using state funds to leverage federal dollars. In addition to funds spent by DDDS out of its budget, the total combined State and Federal expenditures for the current DDDS waiver is anticipated to be over $105 million in FY 15 and over $12.6 million for DDDS day services under the Medicaid State Plan Rehabilitation Option for individuals who are not enrolled in the DDDS waiver. For individuals living with their family, DDDS contracts with Family Support Specialists who assist these individuals and their family to navigate a complex service system. The other major support provided to families is funding for respite. In Fiscal Year 14, the Division provided respite services to 708 individuals. During the first half of FY 15, the Division has thus far provided respite services to 594 individuals. Families who are supporting individuals living at home are looking for a flexible system of supports designed to meet the needs of the individual and the family. DDDS hopes to be able to better meet the needs of families through the Medicaid Family Support Home and Community Based waiver on which it has been working. DDDS FY 16 JFC Presentation - March 2015

Epilogue Requirement: Family Support HCBS Waiver Application “…Developmental Disabilities Services…is directed to move forward with developing and establishing a Family Support Waiver to begin in Fiscal Year 2016. Prior to submission of the application to Centers for Medicare and Medicaid Services the division shall get the approval from the Controller General and the Office of Management and Budget.” Section 175 of the Epilogue of the Operating Budget Act for Fiscal Year 2015, directed DDDS to move forward with developing and establishing a Family Support Waiver to begin in Fiscal Year 2016. Prior to submission of the application to the federal government Centers for Medicare and Medicaid Services, also known as CMS, the division was directed to obtain approval from the Controller General and the Office of Management and Budget. The Division has held two stakeholder focus groups to obtain feedback to enable the Division to address design elements that are necessary to complete the HCBS waiver application. Two critical components required for approval of a Home and Community Based waiver application are case management and person-centered planning. The Division has begun the work to develop a case management system designed specifically for individuals living at home, as well as a person-centered planning process. DDDS will continue to solicit stakeholder input during the development of this program. The division expects to be able to provide the completed application to the Controller General and OMB by June 1, 2015. The Division is also working on companion Medicaid State Plan Amendments to provide Targeted Case Management to two target groups: individuals living with their families and individuals enrolled in the DDDS waiver. These State Plan Amendments are the mechanism by which Targeted Case Management can be funded by Medicaid. Any new HCBS waiver application submitted to CMS must be in compliance with the CMS Community Rule which will be described in the next slide. DDDS FY 16 JFC Presentation - March 2015

Federal CMS Definition of “Community” for Home and Community Based Services The website of the new CMS definition of community is listed below. http://www.medicaid.gov/hcbs The majority of essential services offered by the Division are covered under its Medicaid Home and Community-Based Service (HCBS) waiver. In January of 2014, the Centers for Medicaid and Medicare Services (CMS) released a new rule that defined the characteristics of community-based services funded with Medicaid funds. The new rule was effective on March 17, 2014 and requires that each state submit a Statewide Transition Plan by no later than March 17, 2015 outlining how it will come into compliance with the new rule. Delaware’s plan that was submitted on March 17, 2015 covers both the DDDS HCBS waiver and also home and community-based services provided by the Medicaid Managed Care Organizations under the Medicaid demonstration waiver. In developing the plan, DDDS held focus group meetings with key stakeholders in February to obtain input into its section of the transition plan. A draft Statewide Transition Plan was posted on the DMMA website and comments were accepted from February 6th through March 9th and two public meetings were also held. Public feedback obtained from both sources was incorporated into the Plan that was submitted to CMS. The Plan that was submitted can be viewed on the DMMA website. Even though the official comment period on the Transition Plan ended March 9th, DMMA has indicated that it will continue to accept feedback on the Transition Plan while it is being reviewed by CMS. The state will use the Transition Plan in order to come into compliance with the new Community Rule by March 17, 2019, as directed by CMS. The Governor’s Advisory Council (GAC) to DDDS was designated as the Steering Committee to oversee the process of assessing state and provider policies and standards and the individual settings for DDDS HCBS services. The GAC has already sent letters to a broad stakeholder group inviting them to participate in the process, as we described in the Transition Plan. DDDS FY 16 JFC Presentation - March 2015

Epilogue Requirement: DDDS Provider Quality Standards Epilogue Section 176 of the FY2015 Budget required DDDS to work with specified representatives to develop “additional quality standards for providers” of HCB services. The group must report its findings to the JFC no later than April 1, 2015. Epilogue Section 176 of the FY2015 Budget required DDDS to work with a specified group of representatives to develop “additional quality standards for providers of Home and Community-Based services”. The group must report its findings to the Joint Finance Committee no later than April 1, 2015. The group has met five times and is working to review current DDDS practices and national best practices, to clearly define its mission and to make recommendations to the Joint Finance Committee. In the Epilogue, the Joint Finance Committee also expressed its intent to tie future rate increases to provider quality ratings. Such a change in the reimbursement methodology would be subject to approval by CMS. DDDS FY 16 JFC Presentation - March 2015

FY2015 Provider Rate Increase Direct Support Professional Rate Rebasing Report Submitted in January 2014 $1,169.9 appropriated by the legislature to implement a rate increase for 6 months in FY15 based on the report Funding enabled rate increases in two provider categories that were furthest from the benchmark rates: group home/staffed apartment (5.09% average increase) and day service non-facility (.96% increase) Section 170 of the Epilogue of the Operating Budget Act for Fiscal Year 2014, directed the Division of Developmental Disabilities Services to perform a review of the direct support professional rates and provide a report to the legislature and OMB. The report was submitted in January 2014. The legislature provided $1,169.9 in funding in the FY2015 budget for a 6 month provider rate increase based on the report. That rate increase was implemented on January 1, 2015 for the two provider categories that were furthest from the benchmark rates presented in the report, bringing these rates to a little over 73% of the benchmark rate. That funding enabled the Division to implement an increase for group home and staffed apartment providers of 5.09% on average and for day service non-facility providers of .96%. DDDS is very appreciative of the legislature‘s attention to the rebasing study and its support for increasing the rates based on the findings and methodology from the report. DDDS FY 16 JFC Presentation - March 2015

FY 16 Governor’s Recommended Budget $ 281.9 Annualize FY15 Special School Grads $1,210.6 FY16 Special School Grads $1,842.9 Annualize FY15 Community Placements $1,901.0 FY16 Community Placements $1,169.9 Annualize the FY15 Provider Rate Increase $ 5.9 Lease Escalator DDDS‘s FY 16 Governor’s Recommended Budget includes the following: $281,900 to annualize the FY 15 Special School Graduates funding for day services for 175 clients. These students are in transition from school to find employment or other day services. These services are critical not only to the individuals, but their families as well. $1.2 million for ten (10) months of funding for day services for 150 Special School Graduates leaving school in FY 16. $1.8 million to annualize the FY 15 Community Placements funding for 75 clients. $1.9 million for six (6) months of funding for an additional 75 Community Placements in FY 16. This funding enables the Division to address the transition needs of individuals who are currently living with their families. These individuals have been determined to be in the emergency or high risk category and can no longer be supported by their families. Included in this group are individuals who have elderly parents. The majority of these individuals qualify for the DDDS Medicaid Home and Community Based waiver program. $1.2 million to annualize the FY15 provider rate increase. $5,900 for lease escalator. DDDS FY 16 JFC Presentation - March 2015

Thank you. This Division is very appreciative of the on-going commitment made by Governor Markell, his administration and this General Assembly to support individuals with developmental disabilities. With this commitment, the Division continues to work with self-advocates, families, providers and advocates to meet the challenges of creating, expanding and monitoring a robust system that is responsive to ever changing needs over the person’s lifetime. Thank you. DDDS FY 16 JFC Presentation - March 2015