Maine Department of Health & Human Services Office of Aging & Disability Services Supporting Individual Success For People with Intellectual Disabilities & Autism Information for Members & Their Families

Introductions 2 Department of Health & Human Services Office of Aging & Disability Services 41 Anthony Avenue Augusta, ME (207) Supporting Individual Success web page Director Gary Wolcott Acting Associate Director Karen Mason SIS Manager Jennifer Fales Human Services Research Institute 7690 Mohawk Street Tualatin, OR (503) Vice President John Agosta Policy Analyst Alena Vazquez

Supporting Individual Success Welcome, Introductions & Overview Supporting Individual Success  Purpose of today’s meeting  What OADS is trying to do & why  The new system & how it works  Timeline  What to expect 3

Purpose of Today’s Session 4 We want to share information with you about Supporting Individual Success and also hear what you have to say.

What OADS is trying to do & why OADS wants: People with intellectual disabilities and/or autism to get the services & supports they need to live, love, work play and reach their goals just as others do in the community. This also includes people waiting for services! 5

OADS wants to make sure that the services members get are: 6 Fair for everybody Based on members’ needs and choices Available when people need them What OADS is trying to do & why

We Need to Balance 7 What’s Important to the System What’s Important to People Person- centered system that can last over time

1.Build on the successes we’ve achieved, 2.Be willing to change some things 3.Balance our wants with the best use of the money we have. Moving Forward 8 To move forward and reach our goals, we must:

New System RATES  Adjustments made to rates for some services, including community supports and work supports.  Agency home support services moved from an hourly to a daily rate.  Residential support providers will manage staffing patterns within the daily rate.  No changes to Shared Living and Family Centered Support models. Enhanced rates still available for these services. 9

New System ADDED SERVICES  For individuals living with family or other caregivers, respite services have increased to 350 hours annually.  Semi-independent Supported Living residential option available. FOR MEMBERS  Based on their support needs, members will receive a supports level and corresponding budget that will guide their service choices and planning. 10

New System FOR MEMBERS  Members living in a residential setting (agency group home, family centered support, shared living) will have flexibility with their supports budget for day and work support options.  Members who live at home with their family or other caregiver will have flexibility with their home supports, and day and work support options. There are also respite hours available.  Members who live on their own will have flexibility with how they use their home supports, and day and work support options. 11

Assess Support Needs Supports Level Supports Budget Person Centered Plan Services Delivered How It Works 12 1.Members will have a Supports Intensity Scale (SIS) assessment to assess their support needs. Low Support Needs High

How It Works 13 2.Based on support needs, each member will get a supports level (1-5) Low Support Needs High

Support Level Descriptions LevelDescription 1 Low support need, including little to no support need for medical & behavioral challenges. Supports are typically intermittent rather than 24 hours a day, 7 days a week (24/7). 2 Moderate support needs & little to no support need for medical & behavioral challenges. Although more support than those in Level 1, needs are minimal in a number of life areas. They may also receive intermittent daily support than 24/7. 3 Low to moderate support needs as in Levels 1&2; also above average, non- extensive support need due to behavioral challenges ; or Above average support needs & up to above average, non-extensive support need due to behavioral challenges. 24/7 supports may be needed due to the nature of their support needs. 4 High to max support needs; or significant support needs due to medical condition. Additional 24/7 supports may be needed due to the nature of their support needs. 5 Significant behavioral challenges, regardless of their support need to complete daily activities or for medical conditions. May need enhanced 24/7 supports due to their behavioral challenges.

How It Works 15 3.Based on the supports level, each member will get a base budget Low Support Needs High Low Money High

Day Activities (community & work support) Base Budgets 16 SIS Level Where You live + = Budget The Base Budget for services is made up of 2 parts : Other services like therapies, career planning, employment specialist services, and assistive technology are available if needed but are not included in the base budget.

Base Budget ServicesAdditional Services  Residential Home Supports  Work Supports (Group & Individual)  Community Supports  Respite (Living with Family)  Assistive Technology  Career Planning  Communication Aids  Counseling  Consultation Services  Crisis (Assessment & Intervention)  Employment Specialist  Home Accessibility Adaptations  Non-Medical Transportation  Non-Traditional Communication (Assessment & Consultation)  Remote Support  Specialized Medical Equip & Supplies  Therapy (Occupational, Physical, Speech – Maintenance) 17

Implementation timeline  Members in Section 21 services will be phased in based on their effective personal plan date.  It will take a full year to get all current members into the new system.  In July 2015, OADS will begin sending out letters with supports level and budget information to members with an annual effective personal plan date of January  Roll-out will continue with letters to members in August 2015 who have an effective personal plan date of February

Implementation timeline 19 July 2015 Jan 2016 Aug 2015 Feb 2016 Sept 2015 Mar 2016 Notification Effective Personal Plan Date

Phase-in sequence Planning team discussions PCP completed Case manager submits plan to RC 20 Authorization & services begin July 2015 August 2015 November 2015 December 2015 January 2016 SIS completed SQ Verification if needed SIS Report sent out Supports level assigned Notification letter mailed with supports level & budget  Example for member with effective personal plan date January 2016

SIS Report  Case manager will share SIS report with member (and/or guardian).  Service providers can also request the SIS report for members they serve if the member and/or guardian has signed a release.  SIS report is different than supports level and budget notification letter (described later). 21 SIS Report sent out

Supplemental questions  Used to identify members who may require extra supports for medical and behavioral needs.  For some members, responses to the supplemental questions will need to be verified by the Supplemental Verification Team (SVT).  Safeguard to ensure that people are assigned to a level that will meet their needs. 22 SQ Verification if needed

Supports level notification  Members and/or guardians will receive a notification letter with their supports level and budget information.  In July 2015, OADS will begin sending notification letters to members with an annual effective plan date of January  Service providers can ask to receive supports levels and budget information for members they serve if they have a current signed release of information. 23 Notification letter mailed with supports level & budget

Service planning  Anticipated that implementation year would be more complex, therefore additional 30 days provided.  During phase-in, highly recommend starting initial discussions with members & their team soon after notification.  Particularly important for members with extraordinary needs as might require Extraordinary Review Process. 24 Planning team discussions

Extraordinary review process  A member or guardian, through the case manager, can request a formal review:  If they feel the member’s support needs will not be met by their available service package or  If the member has had a major life change.  Requests will be reviewed by the Extraordinary Review Committee (ERC). 25

Extraordinary Review Committee  The ERC cannot change a member’s assigned supports level but is able to approve services such as Qualified Extra Support Services (QESS) or Skilled Nursing.  ERC is also responsible for reviewing requests for SIS reassessment due to major life change.  Approval will be granted on a case by case basis.  Amount of approved services will depend on the documented and verified need of the member.  Case managers must submit referral form and supporting documentation. 26

Person-centered planning What will stay the same with person-centered planning?  Member and their team will discuss their support needs, goals, and opportunities to access their community. What is new to the person-centered planning process?  Member and their planning team will know their annual supports budget amount.  Member can choose the type and amount of services they want to meet their needs and goals within their annual supports budget. 27 Person- centered planning

Planning with a budget  Services should help the member to lead the life they want with the support they need.  Planning teams can use a supports budget tool to help plan services within the member’s supports budget. 28

Authorization  At least 30 days prior to the Person-Centered Plan effective date, case manager submits plan to Resource Coordinator for authorization.  Once authorized, services begin! 29 Authorization & services begin

Grievance & Appeal Process Planning team discussions PCP completed Case manager submits plan to RC 30 Notification letter mailed with supports level & budget Authorization & services begin Referral to ERC Appeal rights issued Extraordinary Review Service package meets needs Skilled nursing or QESS approved Appeal rights issued No Yes No or not enough Appeal rights issued Yes

MaineCare appeal process  There are three points when you can file an appeal:  After notification of supports level and budget  After Extraordinary Review Committee decision  After services are authorized  If you want to file an appeal, call your case manager. 31

OADS grievance process  As always, if you are unhappy with any part of your services, you can file a grievance with OADS.  For grievance information, go to the link below. ance/home.html 32

Robert  Robert is 52 years-old and lives in a group home with two other housemates.  He been assigned to Supports Level 2, and based on where he lives his annual Supports Budget is $114,519.  He is close with his younger brother Paul, who visits once a week.  He is fairly independent with home living activities, but may need reminders for house cleaning, personal hygiene, and grooming.  He can get frustrated with complex tasks, such as preparing a meal, but does well if someone supports him step-by-step.  He needs assistance getting around in the community, and currently goes to a day program 5 days a week.  Loves to talk about cars and trains, and is excited about the possibility of working with cars. 33

Robert 34 Fairly independent with home living Can follow step-by- step instructions Interest in cars and trains Brother Housemates Home staff Day program staff Case manager Auto repair Oil change Car wash Car dealership Train station iPhone call/ text Digital watch Section 21 MaineCare Social Security Income

Robert 35  Goals:  I would like to have a paying job.  I would like to do more activities outside the house and make new friends.  I would like to take a vacation with my brother and go to a race car event.

Robert 36  During his planning meeting, Robert decided to use a combination of community supports and work supports to reach his goals.  He will use 4 hours per week for work supports with one-on-one staff to help him learn and maintain a job that fits with is interests and career goals.  He will spend 5 hours per week using work supports in a group setting (3 people).  He will use 4 hours of community supports one-on-one to explore opportunities in the community with the hopes of meeting new people who share his interests.  He would also like to keep going to his day program 4 days a week for 4 hours.  On Saturdays, he will spend time with is brother planning their vacation.  This is a total of 25 hours of community and work supports.

Questions? 37