1. Analysis of State’s Licensing/Certification Outcomes Processes Person-Centered Outcomes Respect and dignity  Respectful interactions with staff  Age appropriate dress  Respect for the individual’s culture and religion Rights and responsibilities  P rivacy  Having personal possessions  Receiving payment for work  Voting  Having one’s own possessions  Safeguards for the use of restrictive  procedures Personal safety and risk  A buse neglect  Environment  Individual’s fund

2. Person-Centered Outcomes (continued) Health and Medication  Access to health care services  Routine examinations,  Management and administration  Diet/nutrition  Use of durable medical equipment  Access to needed ancillary clinical supports such as  Occupation therapy and physical therapy Community inclusion and integration  Working in integrated settings  Using local resources and amenities Independence and autonomy  Prepare meals and do chores, perform work tasks and live ad work in accessible settings Choice and decision-making  Everyday choices (e.g., meals, routines, activities)  Higher level decision making (e.g., goals, jobs, homes and housemates)

3. Analysis of State’s Licensing/Certification Outcomes Processes RELATIONSHIP OF PERSON-CENTERED OUTCOMES TO SERVICE PLANNING  Individual involvement in planning  Identifying people's preferences, choices (e.g., services, housemates, work) and personal goals  Assessing/evaluating people’s needs for support  Developing strategies for implementing goals  Monitoring people’s progress

4. Analysis of State’s Licensing/Certification Outcomes Processes SURVEY METHODOLOGY All person centered survey process have the following in common:  A “representative” sample of individuals served by the agency  Surveys are complete through  Documentation Review  Interviews with individuals, staff, family, case managers  All Surveys include observation of individuals in the location where they receive services  Most surveys also include a review of agency related documentation Examples  Staff orientation/training  Investigation reports  Incidents reports

5. Analysis of State’s Licensing/Certification Outcomes Processes SAFEGUARDING OUTCOMES AND REQUIREMENTS The most uniformly prescriptive set of requirements and outcomes: Rights  Informing individuals and family members about individual rights and responsibilities Abuse, neglect and exploitation  Reporting allegations of abuse  Investigate allegations, take action if the investigations are substantiated  Protect individuals from harm  Take action if investigation substantiated Restrictive procedures  Psychotropic medications, behavior support plans, and restraints  Require  assessments  plans  monitoring  external review  prohibitions or limitations on some restriction  Staff training

6. Analysis of State’s Licensing/Certification Outcomes Processes Medications: Prescriptive requirements for management and administration of medications Health  More prescriptive requirements for medications than health.  Require  Routine examinations  Identification of health care needs  Access to health care services  Special diets nutritional meals Environmental:  Greatest requirements  Larger residential living situations  And/or residences that provided 24-hour staffing  Less prescriptive for more independent living situations  People lived in their own apartments  And/or received less than 24-hour supports including  Accessibility required when needed

7. Analysis of State’s Licensing/Certification Outcomes Processes STAFFING AND STAFF TRAINING  Less emphasis on staff educational level and degrees  Staff ratios less prescriptive: tied into individual needs  Staff knowledge and competency seen as an essential safeguards!  Some training required before staff can work alone with individuals  Examples of orientation/training requirements:  Emergency procedures (e.g., evacuation)  Abuse/neglect reporting  Knowledge support strategies for the individual  Administration of medications (if the state has a delegated staff giving medications)  Human rights  Incident reporting  First aid and CPR  Medication administration certification for states that have the delegated model

8. Analysis of State’s Licensing/Certification Outcomes Processes Different Models of Licensing Certification  ONLY LICENSING (MINNESOTA)  COMBINED LICENSING AND CERTIFICATION PROCESS (MASSACHUSETTS)  SOME SERVICES LICENSED, OTHERS CERTIFIED (UTAH)  PROVIDER APPROVAL PROCESS (COLORADO)

9. STATE OF LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS OFFICE FOR CITIZENS WITH DEVELOPMENTAL DISABILITIES LICENSING AND CERTIFCATION REFORM WORKGROUP TASKS OVERALL GOAL: DEVELOP A FRAMEWORK FOR A REVISED SYSTEM FOR LICENSING AND CERTIFIYING SERVICES FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES WORKGROUP TASKS:  Review results of 5 state analysis  Develop a set of operating principles  Develop a core outcomes would apply to all services (refer to what 5 states determined to be important)  Decide what services are subject to a regulatory review process  Decide if there will be separate process for licensing and certification. If yes,…  Decide what is the purpose of each process (e.g., enforcement, enhancement, contracting decisions, people and family members making choices about services)  Decide what services are subject to licensure and services subject to certification  Decide what is the “unit” of service to be certified and/or licensed (e.g., by provide, by location be service type)

10. LICENSING AND CERTIFICATION REFORM WORKGROUP TASK, ( Continued)  Decide what the relationship is between the two processes (refer to the different models among the 5 states)  Decide who is involved in each process if no,…  Decide what will be enforced and what will be service enhancement.  Decide what is the “unit” of service to be certified and/or licensed (e.g., by provider, by location, be service type)  Decide who is involved in the process