My Life, My Community! Waiver Redesign Update with HSRI Recommendations
29
D B H D S Virginia Department of Behavioral Health and Developmental Services My Life, My Community! Waiver Redesign Update with HSRI Recommendations Connie Cochran Assistant Commissioner & Dawn Traver Waiver Operations Manager Virginia Department of Behavioral Health and Developmental Services
description
My Life, My Community! Waiver Redesign Update with HSRI Recommendations. Connie Cochran Assistant Commissioner & Dawn Traver Waiver Operations Manager Virginia Department of Behavioral Health and Developmental Services. Virginia is Shifting the Array of Services. - PowerPoint PPT Presentation
Transcript of My Life, My Community! Waiver Redesign Update with HSRI Recommendations
D B H D SVirginia Department of Behavioral Health and
Developmental Services
My Life, My Community!Waiver Redesign Update
with HSRI Recommendations
Connie CochranAssistant Commissioner
&Dawn Traver
Waiver Operations ManagerVirginia Department of Behavioral Health and Developmental Services
Page 2
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Virginia is Shifting the Array of Services
Nursing Facilities, ICF,Day Support
More Integration and Options for Independence
Group HomesPrevocational
Sponsored Residential
Family HomeGroup Supported Employment
Individual’s Own Home or Apartment, Individual Supported Employment
Current Array of Services
Future Array of Services
Page 3
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Four Main Areas of Settlement Agreement
Serving individuals with DD in the most integrated setting and building quality community-based alternatives for individuals, particularly individuals with complex needs
Quality and risk management system, including monitoring and evaluating services, and implementing quality improvement processes at an individual, provider, and state-wide levelSupporting independent housing and employment options for individuals with DD
Transitions from training centers
Page 4
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Individuals Served By Virginia’s Developmental Disability System
February 5, 2014
Training Center3%
Served in com-munity on ID/DD
Waivers55%
On waitlist for ID or DD waiver
41%
674
10,7978,115
Page 5
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Waiver Transformation Activities
•On July 1, 2013, DBHDS & DMAS awarded a contract to the Human Services Research Institute (HSRI) to study Virginia’s HCBS Medicaid Waivers for persons with ID and DD.
•The study was named “My Life, My Community!”
Page 6
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Goals of My Life, My Community!
1. Evaluate the efficiency, effectiveness and flexibility of the current waivers.
2. Recommend approaches for system changes including waver enhancement, and the potential efficacy of one comprehensive waiver and one supports waiver.
3. Conduct a study of current Medicaid rates.4. Recommend new rate structure based on the study
and exploring an individual resource allocation system for efficient distribution of waiver funds.
5. Aid in implementing the new system.
Page 7
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
My Life, My Community: Two Phases
Phase I• Evaluate the waivers• Hold public stakeholder forums and report
on results• Evaluate SIS administration and create
process for data use• Develop a plan to reduce the number of
waivers• Review policy changes• Report on findings
Page 8
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
My Life, My Community: Two Phases (cont’d)
Phase II• Conduct a cost study and propose a more
appropriate rate structure• Explore a resource allocation framework• Create a rate structure• Evaluate SIS data• Analyze the potential impact of the proposed
waiver system• Align with the Quality Management System• Develop a communication plan
Page 9
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Public Forums
• HSRI held 8 stakeholder meetings across the state between 9/23 and 10/10/13
• All were welcome: self advocates, family members, providers, CSBs, advocacy reps
• The resulting report is available at: http://www.dbhds.virginia.gov/MLMC.htm
• The information gathered helped inform the Phase I report
Page 10
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
My Life, My Community Public Forums Conclusions
Primary Principle: One Unified, Needs-Based Waiver
• The waiver needs to address the increasing demand for services in the state
• The waiver should offer a flexible array of services that allow for choice, control & creativity to meet individual needs & preferences
Page 11
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
My Life, My Community Public Forums Conclusions
(cont’d)• Waiver rates need to be
commensurate with the costs of providing services
• The waiver needs a uniformly implement, sound infrastructure for screening, providing case management/service coordination services that enable users to access services free of conflict of interest
Page 12
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
December 20, 2013: HSRI Phase I
Recommendations• Phase I report included a series of short
and long term recommendations• Available at
http://www.dbhds.virginia.gov/MLMC.htm • DBHDS will evaluate each of these
recommendations, in conjunction with stakeholder input, before making policy decisions or final recommendations
• Final recommendations to Governor for General Assembly consideration at 2015 session
Page 13
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Major HSRI Recommendation
VA should initiate the development of two new 1915(c) Waivers that include eligibility for people with ID, DD and related conditions
– Comprehensive waiver with wide service array, including residential
– Support waiver with similar supports array but no 24-hour residential option
Page 14
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Waiting List Recommendations
Long Term Recommendation• A single set of waiting list criteria should be created
Short Term Recommendations• DD Waiver emergency slots should be available on a
continual basis• DBHDS/CSBs should perform continual outreach to
ensure people know how to apply for services/WL• Review WL data to determine which individuals are
receiving services through other sources/not receiving any services
• Stakeholders should contribute to revised policies that integrate WLs
Page 15
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
CSB Recommendations
Long Term Recommendations• Clarify & strengthen the oversight role of the
state in contract with CSBs & practice related to Medicaid funded activities
• CSBs as single point of entry for individuals with DD added to statute
• Expand role of CSBs as case management entities for those with DD & related conditions
• Develop long-term plan for transitioning CSBs into case management providers vs. Waiver services providers
Page 16
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Case Management Recommendations
Long Term Recommendations• Address conflicts of interest within
the current case management system
• Shift all case management to the public CSB system
• Develop 2 new State Plan AmendmentsoCase management for those on I/DD
waiversoCase management for those not
receiving waiver services
Page 17
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Case Management Recommendations (cont’d)
Short Term Recommendations• Enable ID & DD Waiver case
managers to bill for activities up to 6 months prior to transition to the community
• Administration of the SIS should be done by an independent entity
Page 18
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Service Array Recommendations
Long Term Recommendations• Enhance and encourage Positive
Behavioral Support services• Remove restrictions on “general
supervision” in Congregate and In-home Residential Support services
• Consider stakeholder forum feedback on transportation services
Page 19
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Service Array Recommendations (cont’d)
Long Term Recommendations• Consider adding Caregiver Retention
payments or vacancy factor to rates• Consider adding a “Community
Guide” service to promote community integration
• Add dental services to the waivers
Page 20
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Service Array Recommendations (cont’d)
Short Term Recommendations• Streamline the process for preventing
and addressing crises for those served in the community
• Ensure access to Skilled Nursing services for those with significant medical issues
• Continue to support self-directed service options
Page 21
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Employment Recommendations
Long Term Recommendations• Revise employment service definitions
to align with CMS 2011 employment informational bulletin
• Make discussions about individuals’ career interests a priority before determining day/employment services
Page 22
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Quality Improvement Strategies
RecommendationsLong Term Recommendation• DMAS & DBHDS should create a unified Quality Improvement System for the two new waivers to safeguard individuals and improve their quality of lifeShort Term Recommendation• VA should proceed with revisions to the ID Waiver QIS for the 2014 renewal per draft guidance issued by CMS in August 2013
Page 23
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Incident/Risk Management Recommendations
Long Term Recommendations• Develop a critical incident manual that
clarifies the roles and responsibilities of everyone in the system
• Automatically notify SCs/CMs of critical incidents reported in CHRIS
• Clarify DBHDS role & responsibility for conducting certain types of investigations
Page 24
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Incident/Risk Management Recommendations (cont’d)
Long Term Recommendations• Expand Death Reporting and Mortality
Reviews to all I/DD waiver recipients whose death is unanticipated or unexplained
Page 25
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Next Steps
Response to Phase I recommendations• Stakeholder meetings to further discuss
DBHDS’/DMAS’ response to major issuesPhase II began in January• Burns & Associates to met with a
committee of provider stakeholders for input into the development of a survey for all providers regarding ID/DD Waiver rates– “Provider Advisory Committee”
Page 26
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Stakeholder Groups Being Formed
Waiver Development Advisory Committee•Overarching committee to provide input to the process of new waiver development
Subcommittees:– Provider Advisory Committee – Eligibility Requirements– Waiting Lists– Case Management
Page 27
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
SIS Related Next Steps
• ID support coordinators no longer administering the SIS to individuals receiving ID and DS Waiver services
• DBHDS contracted with an external vendor (AAIDD) to complete the SIS on individuals receiving ID, DD & DS waiver
• Approximately 1,450 SIS interviews to be completed through June, 2014
• The information will be used to inform the rate study.
Page 28
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Timeline for Implementation of My Life, My Community
• Renew Intellectual Disability (ID) Waiver (January 2014 – July 2014)– only make small modifications to the
current program• Design New Developmental Disability
Waiver(s) (January 2014 – January 2016)– The WDAC and subcommittees will provide
consultation and guidance in development of these solutions
Page 29
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Questions?
