1. Athens County Stakeholder Meeting 2015

2. Mission “To support County Boards of Developmental Disabilities (CBDD) in providing services and supports to people with developmental disabilities.” OACB’s Mission

3. Vision "To enhance the lives of people with developmental disabilities." OACB’s Vision

5. History is important! Where we have been helps us understand where we are going… National and state regulations that support a new way of doing our work CMS basic requirements of Home and Community Based Services rule Person Centered Planning- what is it and what is different from traditional approach? Preble county SSAs share examples of what they have developed and what they are learning Agenda

6. How did we get here?

7. Director Martin: Improved efficiency & effectiveness Define our future before others define it for us Olmstead Decision: Community Integration Employment First: Community Employment Future of adult day services Sub Minimum Wage: Future of sheltered workshops Other: Public schools now serve people with DD Self determination Private Providers County Boards Persons Served Families of Persons Served Ohio Developmental Disabilities System Drivers of System Change 2015 Ohio Department of Developmental Disabilities Free Choice of Provider: Privatization Economic Challenges: Increased enrollment Stagnant or declining revenue

8. In 1999, 2 women with DD and psychiatric issues. In state institution; multiple admissions. Professionals agreed, needs of both could be met in community setting. Waited years for community treatment. Olmstead Facts

9. Unjustified isolation is properly regarded as discrimination based on disability. Olmstead Facts

10. 1. People lived at home; 2. We built institutions; 3. We started closing them; 4. Supported living and HCBS Waivers started; 5. Self-determination happened; 6. We got into trouble with HCFA/CMS; 7. Became obsessed with compliance with rules 8. Person centered planning pilots started 9. We drafted great new Rules that emphasize PCP; 10. Employment First happened 11. CMS rule came out 3/14 State of Ohio Evolution of DD Services: CMS/ Olmstead/DRO/Good Life

11. 42 CFR 441.301

12. Written plan (ISP) reflects:  Setting is chosen by the individual and is integrated in, and supports full access to the greater community;  Opportunities to seek employment and work in competitive integrated settings;  Opportunity to engage in community life, control personal resources, and receive services in the community to the same degree of access as individuals not receiving HCBS. CMS and Day Services: 3/17/2014- Issue Date of New HCBS Rule

13. Intended to ensure individuals receiving HCBS services under a Medicaid Waiver “have full access to the benefits of community living and the opportunity to receive services in the most integrated setting appropriate setting.” Applies to both residential and day services. States have 5 years to transition and comply with rule. More About the Settings Part of the CMS Rule

14. Facility-based day service settings and sheltered work centers will probably be considered "settings that isolate;” Need to show how the settings are integrated in and support full access to the community. Volunteering Interning Taking a class Learning about careers and interests Promotes interaction with community Not a disability-specific program The What’s and What Not’s of the CMS Rule

15. What does integration look like? The same planned activities in the home community within all of life’s activity domains: Work Volunteer- work on a political campaign, volunteering at soup kitchen; kennel volunteer Learning experiences and activities; books on tape; adult classes; self-help classes Recreation –having fun/a social life – getting together with friends, going out; peers get together; movies; gambling; shows; Shopping Robin E. Cooper, NASDDDS 3/14

16. What does integration look like? The same planned activities in the home community within all of life’s activity domains: Maintain health and wellness – walking; gym membership; diet groups Personal care – hairstyling, having nails done, Maintaining home; maintenance and improvement; cleaning; laundry Caring for others; relatives or others Spirituality: worship; meditation; yoga classes; meeting groups; sodalities Hobbies: Pet care – walking the dog Robin E. Cooper, NASDDDS 3/14

17. County Boards of Developmental Disabilities have a rich history in developing and operating many legacy programs, and will continue to evolve and transform our system based on what individuals and families expect and demand. Full Range of Employment Opportunities

18. When individuals leave a sheltered experience to try a job in the community, we want to be a safety net for folks that may need to return to board services. Full Range of Employment Opportunities

19. Conflict Free Case Management

20. 42CFR441.301(c)(1)(v) and (vi) Includes strategies for solving conflict or disagreement within the process, including clear conflict-of-interest guidelines for all planning participants Providers of HCBS for the individual, or those who have an interest in or are employed by a provider of HCBS for the individual must not provide case management or develop the person-centered service plan, except when the State demonstrates that the only willing and qualified entity to provide case management and/or develop person- centered service plans in a geographic area also provides HCBS.

21. County boards helped to develop the current “firewalls” document many years ago and are eager to remain partners in the process to define the future of this document. State law and administrative rules currently ensure that the county board of DD system can operate without conflict and should be enhanced to further ensure conflict free case management. Conflict Free Case Management

22. Free Choice of Provider

23. Service and Support Administrators need the necessary tools to ensure that individuals and families have useful information to make informed choices between HCBS providers. The words in the CMS regulation are "Willing and Qualified Provider" to provide services, not "Willing and Able." Unfortunately, anyone that is certified as a provider of a specific service is presumed to be "able" to serve an HCBS waiver recipient. We believe that clarification is needed to distinguish these important concepts. Free Choice of Provider

24. To provide additional safeguards in the provider selection process, County Boards of DD support additional state oversight to investigate complaints or allegations that may potentially violate HCBS Free Choice of Provider. Free Choice of Provider

25. County boards should have the authority and responsibility to recruit providers in a sufficient number to meet the needs of people served on HCBS waivers. Revisions to the County Board of Developmental Disabilities administration rule and the Free Choice of Provider rule will enhance this important function. Quality Services

26. County Boards of Developmental Disabilities are in the best position to serve individuals with complex needs when other private HCBS providers are not qualified or unwilling or unable. Quality Services

27. Person Centered Planning

28. Thought Process  Person-centered planning is mandated;  Monitoring is individualized;  The whole team has responsibility;  Informal supports are primary;  The person drives the planning process and the supports. Required Shift  Move from linear to expansive;  Find your innovative spirit;  Allies, not isolation;  Trust;  Embrace creativity  The path less traveled. SSA Rule Highlights

29. The Intention of Person-Centered Planning Improve the social status of people with disabilities Enhance the perception held of people with disabilities Expand the network of allies and associations in people’s lives

31. History of Change in Our System We Have Been Continuously Improving Discrimination Less Discrimination

32. While providing integrated services to all of the people served by County Boards of DD will be an enormous challenge, with adequate funding, Ohio can make great strides toward achieving the goal of system transformation. By incorporating the philosophy of person-centered planning throughout Ohio’s DD system, County Boards of DD will be able to define quality for a person receiving services. System Transformation

38. Change is a door that can only be opened from the inside!

39. Questions & Answers Thank you for your time and attention today!