1. More About The DDD Assessment “A new way to assess and plan for supports and services for people with developmental disabilities” Aging & Disability Services Administration Chapter 388-828 WAC

2. What is the DDD Assessment? Aging & Disability Services Administration The DDD Assessment is a new assessment process that DDD will begin using on June 1, 2007 to evaluate the support needs of individuals with developmental disabilities prior to making a determination of service need.

3. Why was it Developed? Aging & Disability Services Administration In 2003, a JLARC performance audit of DDD stated: “DDD caseloads are growing, procedures are poorly defined and effective automated systems to help case managers manage their caseloads are missing.” JLARC found that because an assessment process is not consistently applied, it is impossible to determine if clients with similar needs are receiving similar services.

4. JLARC Recommendations DSHS develop an assessment process that: Aging & Disability Services Administration Measures the unique support needs of people with developmental disabilities Is administered before a determination of service need is made Is consistently applied to all people enrolled in DDD in all parts of the state Uses proven, computer-based technology that already exists in DSHS

5. The Challenge Addresses the unique needs of both children and adult who are enrolled in DDD Makes use of similarities between DDD and HCS while preserving each division’s distinct programs Obtains needed information to administer all DDD programs and services Aging & Disability Services Administration Build a single assessment system that:

6. Stakeholder Involvement “Real Choices” Group Regional experts WPAS HCS, RCS, MSD, CA Aging & Disability Services Administration Since 2004, DDD has held regular meetings with stakeholders who provided input into the development of the DDD Assessment application and rules. Counties Residential Providers State Advisory Committee Regional Advisory Committee

7. WAC Development Filing of Pre-proposal Statement of Inquiry on 11/21/05 Monthly meetings with Real Choices Committee Internal review of proposed Rules 8/7/06 to 8/18/06 Copy of proposed rules on DDD web-site 9/4/06 Public review of proposed rules 9/4/06 to 9/15/06 Public review of proposed rules 10/2/06 to 10/13/06 Q & A session with WPAS and CLS on 10/19/06 Cost survey (425 AFHs, 33 GHs, 90 SL providers) Aging & Disability Services Administration Consisted of:

8. WAC Development (cont.) Real Choices Committee Adult Family Home Advisory Board Boarding Home Advisory Board WPAS and Columbia Legal Services HCS, RCS, MSD and Children’s Administration DSHS Board of Appeals and DSHS Operations Review Rules and Policies Assistance Unit (RPAU) Service Employees International Union (SEIU) Aging & Disability Services Administration Solicited review and feedback from:

9. Collaborative Efforts A standardized assessment process that meets the needs of DDD and the individuals served Rules promoting consistent application and understanding of the DDD Assessment process Communication materials to inform individuals, families, advocates, and providers about the new DDD Assessment Aging & Disability Services Administration Have resulted in development of:

10. DDD Assessment Benefits Aging & Disability Services Administration Measures unique support needs of people with developmental disabilities Standardizes assessment process used by DDD Is comprehensive in assessing support needs Records an individual’s service requests Improves planning process for developing an ISP Meets CMS & JLARC expectations Records an individual’s information electronically Integrates current assessment tools and existing case manager work processes

11. The DDD Assessment Support Assessment Service Level Assessment Individual Support Plan Aging & Disability Services Administration The DDD Assessment has three modules:

12. The New DDD Assessment Process Determine Svc Levels Information & Referral Module 1 Module 3Module 2 Plan for Services

13. Module 1: Support Assessment Collects a common set of assessment information for every enrolled individual Promotes consistency in evaluating a person’s support need acuity levels Contains Supports Intensity Scale (SIS) Assessment Determines ICF/MR Level of Care standard for potential waiver eligibility Identifies who receives the Service Level and Individual Support Plan modules in their DDD Assessment Aging & Disability Services Administration Purpose:

14. What is the SIS Assessment? A standardized assessment developed by AAIDD, the American Association on Intellectual and Developmental Disabilities SIS measures: habilitation and training needs of people with developmental disabilities age 16 and older Supports needed for 49 life activities, 8 protection & advocacy activities, 15 medical conditions, and 13 problem behaviors Measures focus on the type, frequency, and duration of supports a person needs to be successful Aging & Disability Services Administration

15. Module 2: Service Level Assessment Determine service levels and/or number of hours for Medicaid/Waiver personal care Identify service levels for residential rate study Determine a seizure acuity level for reporting purposes only Identify employment support levels for people receiving county services (these levels are not used in rate setting) Aging & Disability Services Administration Purpose:

16. Module 3: Individual Support Plan Create a written plan that includes acuity scores generated from the support assessment Document referral information Authorize DDD paid services that people are approved to receive Identify health and welfare needs and the plan to meet those needs for individuals on the waiver Describe DDD’s expectations of providers Aging & Disability Services Administration Purpose:

17. ADSA’s CARE System CARE is no longer just an assessment, it is a system containing: Aging & Disability Services Administration A user-interface that is similar for both HCS and DDD Client details DDD Intake and Eligibility The DDD Assessment for DDD clients The Personal Care Assessment for HCS clients A system interface for authorizing payments for HCS clients Support / service plans

18. DDD / HCS Assessment Differences SIS questions measure supports needed to be successful in the future DDD has incorporated new assessment panels into the CARE system interface which are visible only in DDD Assessments Caregiver Status, Protective Supervision, and Behavior Acuity scales in Support Assessment are only used to calculate service levels for Waiver respite Aging & Disability Services Administration

19. Assessment Differences (cont.) Other acuity scales (ADL, Medical, Interpersonal) are currently used only for the residential shadow rates studyresidential shadow rates study DDD Sleep, Employment Support, and Mental Health panels are only visible to DDD and are used in the residential shadow rates study Both DDD and HCS Assessments contain new Allergy and Seizure panels (these do not effect algorithms) Aging & Disability Services Administration

20. Implementation Timeline Stakeholder work groups……… Communications Efforts………… Public Hearing……………………… Train case managers……………… Adopt DDD Assessment WAC… Begin using DDD Assessment… Post Implementation Support… Aging & Disability Services Administration 6/1/04 to 1/17/07 6/15/05 to Present 3/27/07 5/14/07 to 6/1/07 6/1/07 7/1/07 to 6/30/08

21. Communication Efforts Informational flyers to self-advocates, families, and stakeholders Informational DVDs, newsletters by the Arc of Washington and the DD Council Monthly talking points for DDD Field Services Staff Web-site regarding Assessment project Presentations to: – Statewide residential & employment conferences – State & Regional Advisory Committees – Residential & other service providers – DDD Field Services Staff Aging & Disability Services Administration http://www1.dshs.wa.gov/ddd/CAP.shtml

22. What to Expect Before an assessment is due, individuals and families will be contacted in advance to schedule a meeting They will receive an appointment notice and information about the new DDD Assessment A case manager will perform the assessment face-to-face with the individual and at least one other person who knows him or her well The assessment will take place in the individual’s home They will receive a copy of the Assessment Details, or an Individual Support Plan, depending on the services they receive Aging & Disability Services Administration

23. Remember Everyone will be asked the same questions. There are no right or wrong answers. Case managers, advocates and representatives are available to answer questions about the assessment. Services cannot be authorized without an assessment. Individuals have the same rights to appeal that they have now. Aging & Disability Services Administration

24. For More Information Aging & Disability Services Administration Visit the DDD Assessment Project Website: http://www1.dshs.wa.gov/ddd/CAP.shtml or Contact your Case Resource Manager