1. Employment Services for Iowans with disabilities Redesign Update

2. May 27, 2014 Iowa Community of Practice Lin Nibbelink, Iowa DHS Division of Mental Health & Disability Services LeAnn Moskowitz, Iowa Medicaid Enterprise

3. Changing the question to change the culture From “Do you want to work?”

4. TO “What work do you want to do?”

5. Movement on the Landscape  Change is happening all across the nation  Recent Findings by U.S. DOJ and Labor in Oregon, Rhode Island, and New Hampshire: segregated services violate the integration mandate of the ADA, and the U.S. Supreme Court’s “Olmstead” ruling “most integrated setting” requirement  The Centers for Medicare and Medicaid Services (CMS) issued guidance (Sept, 2011) describing expectations for pre-vocational services offered within sheltered workshops.  Title 14(c) of the Fair Labor Standards Act is under review in the U.S. Congress.  MHDS Redesign Core Services definitions and rules; Regions required to do “Evidence-based practices (EBP)”; Supported Employment is an EBP

6. Systems Change Iowa has been working on Employment for people with disabilities, for some time! 2005+ –Consumer workshops & Self Employment (MIG) 2009 –E1st focus groups and Summit (MIG) – Joined State Employment Leadership Network (SELN) 2010 – SELN “Findings” Report – MIG Pilot projects on Customized Employment 2011, 2012– SELN researched other states, made recommendations, produced “Capacity Building” report – DOL ODEP EFSLMP grant awarded to IVRS – DOL DEI grant awarded to IWD 2013– Key Assumptions document – Distilled the “Stakeholder Brief” document, used to kick off Community Conversations

7. During June 2013 Community Conversations in 5 places around Iowa, sought input from a broad range of stakeholders In collaboration with Iowa Vocational Rehabilitation Services (IVRS), the Iowa DD Council, and the Iowa Coalition for Integrated Employment (ICIE); Facilitated by Dale Verstegen, TransCen; 152 people Workgroup members auditioned and were selected to represent a balance of rural-suburban-urban, large and small providers, those who do only facility based services, those who do community based only, and those who do both

8. Workgroup Activities 30 participants representing parents, siblings, 14 provider agencies, case management, county & state funders Intense all-day facilitated work meetings twice/month in Ames or Johnston, with homework in between Employment service definitions: July 11 & 23 Provider requirements, staff qualifications, staff training: August 8 & 13 Reimbursement Methodologies: September 10 & September 26, October 8 & 31 Feedback Webinars - July 26, August 28, September 25

9. We are all working hard to craft system changes so individuals have an expanded array of choices for employment and wrap-around supports!

10. Recommended changes to: Service definitions for: Prevocational Supported employment Day habilitation Service provider standards and staff qualifications for all the above Medicaid rates, to support quality staff & quality services

11. SELN Sample Rate Model p.1

12. SELN Sample Rate Model p.2

13. For Rates, we landed on a combination of… Workgroup “Average” recommendations Recommendations by national experts (SELN, ODEP) Salary ranges for comparable positions in State government Salary numbers based on provider time- studies

14. Next Steps Continue work to implement proposed changes Keep working with SELN and ODEP experts to fine-tune potential rate model Keep working with IVRS & other partners Continue cost-modeling out projections for blending/braiding IVRS/DHS Continue cost-modeling out long term projections Apply sample models to current claims to estimate impact Draft Waiver Rules & invite comments from partners & consumer advocacy community Submit to CMS Submit Report to Legislature per HF2463 (p.73, sec. 65)

15. What can you do? Join the Iowa Coalition for Integrated Employment, iowaemployment@gmail.com Explore how your agency can be a part of the system redesign Ask how your agency’s business model today fits the funding realities of the future (Region, Medicaid, Managed Care, Other) Candidly express your fears and concerns, and offer solutions Continue asking questions

16. Resources MHDS Employment Website: http://dhs.iowa.gov/mhds/disability-services/employment IVRS Website: http://www.ivrs.iowa.gov/ ODEP’s Employment First initiatives: http://www.dol.gov/odep/topics/EmploymentFirst.htm http://www.dol.gov/odep/topics/EmploymentFirst.htm Lin Nibbelink, Email: lnibbel@dhs.state.ia.uslnibbel@dhs.state.ia.us DHS – MHDS,1305 E Walnut St., Des Moines IA 50319 PH: 515.281.3023FAX: 515.242.6036 LeAnn Moskowitz, Email: lmoskow@dhs.state.ia.uslmoskow@dhs.state.ia.us DHS - IME, Bureau of Long Term Care 100 Army Post Road, Des Moines, IA 50315 PH: 515.256.4653 FAX: 515.725.1360