Presentation1 - Westchester Institute for Human Development · • no use o ess ma ure behavior •...

10/15/2013

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Westchester Institute for Human DevelopmentUniversity Center for Excellence in Developmental Disabilities

Hudson Valley Regional Center for Autism Spectrum Disorders Conference October 21st 2013

John Maltby M.S.

Where we come from

“Th h d ’t k hi t d ti d t t it”


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http://www.ncld-youth.info/index.php?id=61Retrieved June 2012

“Those who don’t know history are destined to repeat it”Edmund Burke. 1729‐1797

Where we come from.

1974, Willowbrook. The awful place with the beautiful name.


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Where we are

NY State•DCs •ICF•IRA Supervised•IRA


Group Homes, “In the Community”. ‐ They’re not for everyone.

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Supported•Family Care

•“Shared Living”

Sheltered WorkshopsNo more toopen after July 2013


Where we are going.. It’s a BIG DEALConsumer Directed Services


Moving from Adoption Option to independence. The challenge of choice, risk and self reliance.

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Transition, it’s not just 13 & 14

• Secondary to Post Secondary Education

• Employment

• Medical Transition


• Transportation

• Housing

• A life in the Community.

http://www governor ny gov/olmstea

Required Reading !


John Maltby T-6910 Fall 2013 8

http://www.governor.ny.gov/olmstead/home

Person Centered Planning….. And Execution

•Planning without outcomes has no purpose•In transition years you may have..•An IEP, an IPE, and an ISP, •An MSC, a CSS worker, a teacher, an ACCES‐VR Counselor, a Job coachThi ll b f l


•This can actually be useful.

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“Never let a good crisis go to waste”• Budget Woes

• NY Times articles

• CMS and budget

• New governor

• New Graduation Standards


New Graduation Standards

• Olmstead action

• Justice Center

• New OPWDD management

• New Waiver(s)

• New ACCES‐VR CRS

• Affordable Care Act

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Fundamental Shift

• Institutional capacity & sustainability• Demographic pressure• Labor Force inelasticity• Changing perceptions of disability


Changing perceptions of disability• Providers become vendors• Regulatory simplicity.• Reduced Engineering• Consumer resources• Cost

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•“First you get the Money, then you get the power” (The Tony Montana rule)

Getting Started. Do you have a Developmental Disability?

• NY State Mental Hygiene Law – defines Developmental Disability as..• “A disability attributable to mental retardation, cerebral palsy, epilepsy neurological impairment of ti th lti i t l t d ti


autism, or other… resulting in mental retardation• Originates before age 22• Is expected to continue indefinitely• Constitutes a substantial handicap to normal functioning in society.”

• An antiquated definition, but not currently subject to change

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IEP DiplomaTime to Say Good‐bye

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IEP diploma eliminated due to advocacy:

• meaningless document

• not a diploma at allNYS IEP

diplomas will


h not a diploma at all

• Not recognized as a path to employment or college

diplomas will not be issued

after June 2013.

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Skills and Achievement Commencement Credential (SACC)

• Only for students with severe disabilities who are alternately assessed. (NYSAA)

• Focuses on skills


• Focuses on skills.

• Can be used as a planning tool.

• Form/exit summary may be reviewed throughout high school.

Certificate of Career Development and Occupational Studies

• Focused on employment• Non-diploma credential signifying entry-level

work readiness • Can accompany a Regents or local


Can accompany a Regents or local diploma or stand alone as the primary exiting credential

• Requires a student developed career plan • Requires meaningful career development

opportunities and work-based learning opportunities

Formal steps

• Guardianship or Health proxy• Apply for SSI• Benefit optimization• School Triennial


• School Triennial• ACCES_VR application• Evaluations for OPWDD• Waiver eligibility• CSS application• Selective Service

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Education

• It doesn’t end with High School

Higher Education Opportunity Act of 2008The Higher Education Opportunity Act (HEOA) (PL 110-315) was enacted on August 14, 2008, reauthorizing the Higher Education Act (HEA) of 1965. This


law contains a number of important new provisions that improve access to postsecondary education for students with intellectual disabilities.Of particular note are the new provisions for financial aid and the funding of twenty-seven Transition Postsecondary Education Programs for Students with Intellectual Disablities (TPSID) and a National Coordinating Center.

http://www.thinkcollege.net/

http://www.youtube.com/watch?v=43mk9Fy8lbU

The GAELS Rice program at Iona College 5.11 minutes

From Workshop to Workplace, ‐NY is an “Employment First” State


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• Apply during penultimate year of High School

• Limited duration support for ultimate competitive employment

C R h bilit ti S i d Y th

Employment


• Core Rehabilitation Services and Youth Employment Services initiative

• NYSED P‐12 & ACCES‐VR concordat

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NYSACRA Shared Living. Income. 6.1 July 2012 JM 23


NYSACRA Shared Living. Income. 6.1 July 2012 JM 24

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Benefit Myths & Reality

• A way to start or keep working and still optimize

benefits. http://www.ilr.cornell.edu/edi/pass/Retrieved October 2013

http://www.socialsecurity.gov/ssi/spotlight


25NYSACRA Shared Living. Income. 6.1 July 2012 JM

s/spot-impairment-relatedwork.htm

Are you eligible for OPWDD services?OPWDD Front Door

• Contact Mathew Faulkner at Westchester County Dept. Community Mental Health. DCMH submits to OPWDD Developmental Disability Regional Office. 914 595 5253

• Contact the Regional Office for OPWDD eligibility Determination 914 332 8960


Determination. 914 332 8960• Medicaid: Apply for Supplemental Security Income from the Social Security Administration. Confers automatic Medicaid enrolment.

• Or: • Apply directly for Medicaid.

Based on the young adult’s income, not yours

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Assessment by the DDRO

Developmental Disabilities Profile (DDP2)

Coordinated Assessment System, (CAS).

• Disability based• Deficit based• Gateway to congregate

• Currently testing with 22 Case Study agencies

Ad i f h I RAI


• Gateway to congregate services

• Emphasize what you cannot do.• Behavioral• Adaptive• Health• Score creates the budget

• Adaptation of the Inter RAI

• Functionally based

• More appropriate for budgeting

• More person centered.

• In pilot phase

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•Must have OPWDD eligibility, Medicaid and justify the need•Front Door: Access Services•Choose an MSC (individuals receiving this service can choose

a new MSC at any time)

Apply for Medicaid Service Coordination (MSC) or Plan of Care Support Services (PCSS)


a new MSC at any time)•Apply for waiver, similar guidelines for eligibility. (waiver

allows a person to access most services offered by OPWDD)

•Developing the Individual Services Plan (ISP)

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Legacy OPWDD services.• Day Programs

• Day Habilitation

• With walls/without walls

• Pre‐vocation Program

• Employment Training Program

• Blended


Blended

• Supported Employment (SEMP)

• Enhanced Supported Employment (ESEMP)

• Community Habilitation (CommHab)

• Respite/Recreation

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Consumer Directed Services

• Individual & Community Supports (ICS)

• A Person centered funding allocation system.

• Individual Needs Assessment leading to Personal Resource Allocation (PRA) or budget

• Services purchased from traditional agencies


• Services purchased through Consolidated Supports & Services

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What are Consolidated Supports and Services (CSS)?

• Funding conduit directed by the individual

• Based on a Person Centered Plan created in partnership with‐

• The Person


• The Circle of Support

• Their MSC and

• The Start Up broker

• Once approved by OPWDD, plan is funded via the Financial Management Service (FMS) Agency

• Support Broker works to sustain the plan

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How do I access CSS?

• Contact the DDRO to set up a meeting with a “CSS specialist”

• Complete the necessary steps with the specialist• Approval letter for CSS from DDRO• Choose a Start-up Broker and FMS and Sign the Broker

Agreement


Agreement• Circle of Support/Person Centered Planning Meeting• Create a Plan and Budget• Submit to DDRO/OPWDD Central Office• Launch Plan• Support Broker works to sustain the plan with the Support of

FMS. Individual keeps their MSC.

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American Academy of Pediatrics: Four Elements of Transition

• Including health‐care providers along with other service providers in transition planning

• Promoting opportunities for youth to be active in their


own health‐care decision‐making

• Parental support for giving youth more responsibility and independence – balancing need for safety with need to become adult

• Continuity between pediatric and adult health‐care providers

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Medical Transition


Barriers to Transition: Physicians’ Viewpoint

• Pediatrician may distrust expertise of ACP

• ACP may be less familiar with conditions

ACP t d t l t b h i


• ACP not used to less mature behavior

• ACP may have difficulty with atypical appearance and behavior

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Skills Young Adults Need to Manage own Health Care

• Making appointments

• Managing medications


• Speaking up at doctor’s office

• Sharing medical information

• Creating portable medical summary

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Empowering Young Adults to have a Healthy Life-style

• Must understand nutrition and exercise needs

• Reproductive education if applicable

• Should have health goals and a health plan


Should have health goals and a health plan

• My Health, My Choice, My Responsibility –curriculum ‐ download at www.wihd.org

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House & Home transition


Changes in housing

Housing:New York Cares List for Group Homes.

•HousingIRA (Individual Residence Alternative)

Supervised Supported


ppICF (Intermediate Care Facility)Family Care.

•State Wide there are 12,000 adults on the waiting list for housing•BUT! There are other options

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No place like home


WDAP Housing June 2013 40

The Good News!

• Historic alignment of;• You get to direct services to where you need them• Best practice from Evidence Based Research• Self Advocacy Goals


• Federal Policy• State policy• Funding• Taxpayer and community interest.

• Are our provider agencies ready to become vendor agencies?

• Is our state ready to change?

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What do we need to be keeping an eye on?

• OPWDD and Provider agencies continue to think /allocate “Day Habslots” rather than jobs and group home “Beds” rather than homes.

• Undeveloped and un‐”scalable” development and reporting systems, absurdities.

• Lack of System coordination, e.g. NP Act and IRS.

• Equity between system based providers, and innovative providers.


Equity between system based providers, and innovative providers.

• Medicaid “Notice of Decision” appeals

• Part 633 4(a)(viii)(a) modification of ISP. Additionally, Appeal sec4(a)(viii)(b). Objection to Services Process is found in Part 633.12.

• Pits the “haves” vs. the “have‐nots”, and “have not entered”.

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Risk Management

• Identification

• Prioritization

• Management

• Technology


Technology

• Transparency

• Regulation

• Current risks in institutionalization

• “Unknown unknowns”.

• FMS risk

• Employee risk

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“An educated consumer is our best

t ”


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customer”The Sy Syms rule

Helpful references

Front Door http://www.opwdd.ny.gov/welcome‐front‐door/resource‐bookletBalancing Incentive Program http://www.health.ny.gov/health_care/medicaid/redesign/docs/revised_bip_program_application.pdfRoad to Reform.h // dd / dd b / i i /OPWDD R


http://www.opwdd.ny.gov/opwdd_about/commissioners_page/OPWDD_Road_to_Reform_April2013Transformation Agreement. http://www.opwdd.ny.gov/opwdd_about/commissioners_page/04012013_partnership_plan_stcs_attachment

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Eligibility• Benefits

• SSI/SSDI www.ssa.gov/pgm/ssi.htm

• Medicaid http://www.health.ny.gov/health_care/medicaid/

• SNAP (Supplemental Nutrition Assistance Program) http://socialservices.westchestergov.com/food‐stamps‐snap

• HEAP (Home Energy Assistance Program) http://socialservices.westchestergov.com/temporary‐assistance/home‐energy‐assistance

• OPWDD (Office for People with Developmental Disabilities) www.opwdd.ny.gov

• “Traditional Services”

ICS/CSS


• ICS/CSS

• DSS (Department of Social Services) www.socialservices.westchestergov.com

• CDPAP (Consumer Directed Personal Assistance Program)

• ACCES‐VR (Adult Career and Educational Services‐Vocational Rehabilitation) www.acces.nysed.gov/vr/

• ILC (Independent Living Centers)

• PARATRANSIT http://transportation.westchestergov.com/index.php?option=com_content&view=article&id=671&Itemid=59

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