1. SPINA BIDFIDA ASSOCIATION OF NORTHEASTERN NEW YORK What’s Hot in OPWDD? New Initiatives Available for People with Spina Bifida September 6, 2014 9/6/141Spina Bifida Association

2. HCBS Settings Kate Marlay 9/6/142Spina Bifida Association

3. Key Elements of HCBS settings The setting is integrated in, and supports full access to, the greater community; Selected by the individual from among setting options; Ensures individual rights of privacy, dignity and respect and freedom from coercion and restraint; Optimizes autonomy and independence in making life choices; and Facilitates choice regarding services and who provides them. 9/6/143Spina Bifida Association

4. Key Elements of the Final Regulations In provider controlled residential settings : Individual must have legally enforceable lease/agreement Individual has privacy in their living unit including: Lockable doors Choice of roommates Freedom to furnish/decorate Individual controls own schedule Individual has access to food at any time Individual can have visitors at any time Physical accessibility to the setting 9/6/144Spina Bifida Association

5. Self Direction Kate Bishop 9/6/145Spina Bifida Association

6. History of Self Direction 6 For many years individuals and families have been seeking more control over their supports and services. Many found what they were seeking through the 800+ providers certified by OPWDD to deliver services. Others wanted a mix of services; some or all of which they could control or “self-direct” themselves. In 2001, OPWDD began to offer self direction under a service category called Consolidated Supports and Services” or CSS. 9/6/14Spina Bifida Association

7. What is Self Direction? Self Direction provides individuals we supports you the opportunity to make decisions about what supports and services they need to help them: Enjoy meaningful relationships with friends, family and others in your lives Experience personal health and growth Live in the homes and community your choose and Work, volunteer, or do recreational activities you enjoy with others in your neighborhoods. 79/6/14Spina Bifida Association

8. Self Direction allows individuals more choice and flexibility over their services by offering two authorities: o Employer Authority o Budget Authority Individuals who self direct also accept the added responsibility for helping to manage, (co-manage), their supports and services. 89/6/14Spina Bifida Association

9. Allows the person receiving services, rather than the agency, make decisions about who works for you. You can recruit staff, decide what hours you need their help, and supervise their activities. A Fiscal Intermediary agency conducts necessary background checks and performs payroll functions for staff hired on the individual's behalf. 9 Employer Authority 9/6/14Spina Bifida Association

10. Budget Authority: Allows the person receiving services to manage an OPWDD approved budget allocation and the individual and others they trust make decisions about what supports and services they need and who will provide those supports. A Fiscal Intermediary agency co-manages this budget on the individual’s behalf. 109/6/14Spina Bifida Association

11. Where we are with Self Direction Today 11 OPWDD is undergoing extensive reforms that will affect the structure of many of our services. Many services, including CSS will undergo specific changes to align with these reform efforts. However, we remain committed to offering self directed opportunities. We’ve spent the last several months redesigning self direction in ways that will allow for more self directed choices. 9/6/14Spina Bifida Association

12. Effective October 1, 2014 There will no longer be a separate CSS plan for SD. Each service in a person’s current SD plan will align with a HCBS Waiver or state supported service. New self direction options will be built into our basic menu of services Several new services are being added our HCBS Waiver to support self direction More providers will be supporting people to self direct 129/6/14Spina Bifida Association

13. Self-Directed Services Align w/ HCBS Services 13 Self-Hired /Individual Directed Services** Services Supporting Self Direction Community HabilitationLive-in Caregiver (monthly unit) SEMPSupport Brokerage (1/4 hour unit) RespiteFiscal Intermediary (monthly unit) Individuals Directed Goods & Services ($10 per unit) Community Transition Services (one-time payment) **Billed in ¼ hour units 9/6/14Spina Bifida Association

14.  October 1 st is a fast approaching timeline  There are presently about 2000 active CSS/self direction plans and an additional 500 plans ready and waiting to be approved.  Districts are hard at work converting these plans to a new template that will support our new reform by the October 1 st as we are committed to continuity of services for everyone who has been self directing their services under CSS. 149/6/14Spina Bifida Association

15. How to Find Out more about Self Direction? Each OPWDD Development Disabilities Regional Office (DDRO) has at least one Self Direction Liaison. Contact names and numbers are on our website @ http://www.opwdd.ny.gov/node/1776 http://www.opwdd.ny.gov/node/1776 Your Service Coordinator (MSC) or Self Direction Liaison is where you begin the conversation. You can decide to self direct some or all of your services. MSCs and Liaisons will work with you to choose options that will best meet your needs. 9/6/1415Spina Bifida Association

16. Person Centered Planning Shelly M. Okure 9/6/1416Spina Bifida Association

17. What is Person Centered Planning? A process that promotes:  Listening to the individual  Understanding what they feel is important  Learning how and where they want to live 17 9/6/14Spina Bifida Association

18. It Doesn’t…  Focus on deficits and ways to remediate them  Focus on fixing or changing a person. It …  Discovers the interests, skills, strengths and needs of a person.  Builds on what works for them and helps them plan for a quality life based on outcomes that are meaningful to them.  Is often referred to as a “discovery process”. 9/6/1418Spina Bifida Association

19. System Centered to Person Centered FROM Treatment/programmatic focus Segregated Programs Focus on filling slots, beds and residential placements Individuals often stereotyped and “placed” with other with similar diagnoses or challenges Regulations, Policies and Rules used to govern activities TO Individualized plans based individual’s strengths, interests and needs, Help people be members of their communities Support people to live as independently as they are able Help people to develop friendships 9/6/1419Spina Bifida Association

20. Person Centered Planning (PCP) Methodologies  There are several PCP methodologies:  Personal Futures Planning, Dr. Beth Mount  Essential Lifestyle Planning, Michael Smull  Making Action Plans (MAPS), Jack Pearpoint and Marsha Forest  Wheel Power, NYS Self Advocacy Association  All share the same fundamental philosophies and principles: to help people live, work, volunteer, and recreate as independently as they are able in communities they choose. 9/6/1420Spina Bifida Association

21. EIGHT ESSENTIAL HALLMARKS OF PERSON CENTERED PLANNING - a clear alignment with the HCBS Settings Regulations 9/6/1421Spina Bifida Association

22. 1.The person and people important to him or her are included in lifestyle planning, opportunity to express preferences, exercise control and make informed decisions. 2.The person’s routines, supports and services are based upon their interests, preferences, strengths, capacities and dreams. 3.Activities, supports, and services foster skills to achieve personal relationships, community inclusion, dignity and respect. The person makes meaningful choices, with decisions based on his or her experiences 9/6/1422Spina Bifida Association

23. 4. The person uses, when possible, natural and community supports. 5.The person has meaningful choices, with decisions based on his or her experiences. 6.Planning is collaborative, recurring, and involves an ongoing commitment to the person. 7.The person’s opportunities and experiences are maximized, and flexibility is enhanced within existing regulatory and funding constraints. 8.The person is satisfied with his or her activities, supports, and services. 9/6/1423Spina Bifida Association

24. 21 CQL POMs of Greatest Importance to People Are connected to Natural Support Networks Have Best Possible Health Exercise Rights Are Free from Abuse and Neglect Decide when to share personal information Choose where they Live in integrated settings Perform different social roles Choose personal goals Participate in the life of community Are respected 9/6/1424Spina Bifida Association

25. 21 CQL POMs of Greatest Importance to People (con’t) Have Intimate Relationships Are Safe Are Treated Fairly Experience Continuity and Security Choose where & with whom they live Use their environments Interact with others in the community Choose services Realize personal goals Have friends 9/6/1425Spina Bifida Association

26. Personal Outcome Measures Personal Outcome Measures will provide a Framework for Person-Centered Quality Oversight The method OPWDD has chosen to use to help measure individual’s quality of life and the support areas in which are Personal Outcome Measures (POMs) developed by the Council on Quality and Leadership (CQL). 9/6/1426Spina Bifida Association

27. CONCLUSION All topics today move us to a system where we listens to people we serve and determine, from them, if they are being supported in ways important to them. This is not just occurring in NYS but a National Movement. OPWDD has been working with the Committee on Medicaid and Medicare Services (CMS) to design these reform efforts. The federal government has been providing guidance to all states related to the rights of individuals to make informed choices that will lead them to lives they consider to be rich and rewarding. 9/6/1427Spina Bifida Association

28. CONCLUSION It is a challenging time as these reforms represent a significant shift to how services have been deigned and implemented historically. However, the more we hear the from people whose lives have been shaped through person centered principles and by those who self direct their services how satisfied their lives are today, we know we are on the right course. 9/6/1428Spina Bifida Association