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Transcript of Virginia’s ISP Redesign - vaACCSES€¦ · DBHDS Vision: A life of possibilities for all...
DBHDS Vision: A life of possibilities for all Virginians
Virginia’s ISP Redesign and the CMS Final Rule
Presented by Eric Williams, CRC
Provider Development
DBHDS Division of Developmental Services
June 2015
vaACCSES Provider Summer Conference
The “real” policies are written in the hearts of people and will express themselves in practice notwithstanding what is contained in official policy.
Michael Kendrick (2000)“When People Matter More Than Systems”
Overview
Today includes:
How key CMS plan requirements have impacted Virginia’s PC ISP;
Overview that demonstrates the development of the comprehensive plan;
An opportunity for questions.
CMS Final Rule
Focuses on:
• Enhancing quality
• Adding protections
• Full access to the benefits of community
Defines Person-Centered Planning Requirements
Reflect clinical and support needs that have been identified through a functional needs assessment.
CMS PlanRequirements
Person
SIS
Part V Plan for Supports
PC Reviews and Learning
At the Annual ISP
Meeting
After the Annual
ISP Meeting
Before the Annual
ISP Meeting
The ISP Learning Cycle
Important TO
Important FOR
Part III Shared
Planning
Part IV Agreements
Part II Personal Profile
Part I Essential
Information
STARTDocumentation
Slide 10
Part I Essential
Information
Part II Personal Profile
Part III Shared
Planning
Part IV Agreements
Part V Plan for Supports
• Reflect the individual’s strengths and preferences.
• Be understandable (e.g. linguistically, culturally, and disability considerate) to both the individual receiving HCBS/the individual’s support system.
CMS PlanRequirements
• Led by the person/representative where possible;• Includes people chosen by the person;• Provides needed support to direct;• Times and locations are based on the individual;• Reflects cultural considerations;• Be written in plain language and accessible to
individuals with disabilities and personswho are limited English proficient…
CMS ProcessRequirements
Reflect the services and supports (paid and unpaid) that will assist the individual to achieve identified goals, and the providers of those services andsupports, including natural supports.
CMS PlanRequirements
Part I: The Essential Information
Friends & Community Contacts
ISP: Part I Essential Information
Before the Annual
ISP Meeting
Part II: The Personal Profile
Who can be a Planning Partner?
A friend…family member…
support provider…
Part II: The Personal Profile
What does a Planning Partner do?
Helps the individual with:
-gathering information, -arranging planning meetings,-contacting partners,-identifying off-limit topics,-communicating with the SC.
People under guardianship or other legal assignment of individual rights, or who are being considered as candidates for these arrangements, should have the opportunity in the PCP process to address any concerns.
CMS ProcessRequirements
Part I: The Essential Information
Representation
ISP: Part I Essential Information
Before the Annual
ISP Meeting
Prevent service duplication and/or the provision of unnecessary services/supports.
Includes individually identified goals and outcomes.
Reflect risk assessment, mitigation, and backup planning.
CMS PlanRequirements
2626
What makes a person happy, content, fulfilled
• people, pets
• daily routines and rituals,
• products and things,
• interests and hobbies,
• places one likes to go
Important TO
2727
What we need to stay healthy, safe and valued
• physical and emotional health
• safety and security
• things that make you valued in community
Important FOR
Slide 29
Community
Work Learning
Relationships
Home
Transportation & Travel
Health & Safety
MoneyTO FOR
Part II: The Personal Profile
Slide 32
ActionPlanning
Traditional Planning
Separate GoalsObjectivesStrategies
SharedOutcomesAction Steps• Instructions
Part III: Shared Planning
Slide 34
Writing outcomes…
Name important TO.
Writing an outcome based on the heart of each issue
provides for a variety of ways to support a person having
what he or she wants.
Part III: Shared Planning
Slide 35
Writing outcomes…
Steve eats dinner with his friends.
Previous outcome example:
Steve goes to Pizza Shack in order to eat with his friends.
Updated outcome examples:
Steve spends time with his friends. Steve goes out to eat.
Part III: Shared Planning
Slide 36
Part V: Plan for Supports
Writing activities/action steps…
Name action verb activity.
Writing an activity is based on what can be seen when
supporting a person to learn or have what he or she
wants.
Slide 37
Community
Work Learning
Relationships
Home
Transportation & Travel
Health & Safety
Money
Outcome: 1. Steve eats dinner with his friends.
Personal Profile: Important TO
Part III: Shared Planning
Slide 38
Outcome: 1. Steve eats dinner with his friends.
Steve makes dinner plans.
Steve chooses and invites his friends.
Steve goes to dinner with his friends.
Steve cooks dinner for his friends.
Day Support*
Residential*
Residential*
Friend
Who?
Plan for Supports*
Part III: Shared Planning
Slide 39
Residential
Who?Skill-building? Yes No
When Steve can use the internet or phone book to locate preferred restaurants and identify, call and invite at least 3 friends to a meal.
Supports are no longer wanted/needed when…
Can a skill be developed?
Can assistive technology be used?
Can natural supports be introduced?
Can the condition improve?Guiding
questions
Steve makes dinner plans.
Part III: Shared Planning
Slide 40
Community
Work Learning
Relationships
Home
Transportation & Travel
Health & Safety
Money
Outcome: 1. Steve has his own business and makes more money.
Personal Profile: Important TO
Part III: Shared Planning
Slide 41
Outcome: 2. Steve has his own business and makes more money.
Steve budgets his money to save $500.
Steve obtains an employment evaluation.
Steve obtains a business license.
Steve develops a business plan.
Support Coordinator*
Supported Employment*
Residential*
Who?
Supported Employment*
Plan for Supports*
Part III: Shared Planning
Slide 42
Skill-building? Yes No
Supports are no longer wanted/needed when…
When Steve develops a business plan that contains all necessary elements and presents it to the small business development center.
Steve develops a business plan.
Supported Employment
Who?
Can a skill be developed?
Can assistive technology be used?
Can natural supports be introduced?
Can the condition improve?Guiding
questions
Part III: Shared Planning
CMS PlanRequirements
Reflect risk factors and measures in place to minimize them, including individualized backup plans and strategies when needed.
Part II: The Personal Profile
What active medical or behavioral support needs must be planned for with Mary?
Part II: The Personal Profile
Active Medical and Behavioral Support Needs: Mary
ISP: Part I Essential Information
Before the Annual
ISP Meeting
Part II: The Personal Profile
Active Medical and Behavioral Support Needs: Mary
ISP: Part I Essential Information
Before the Annual
ISP Meeting
Part II: The Personal Profile
We need to begin thinking about how active medical and behavioral support
needs relate to the important Toinformation.
To plan successfully…
Part II: The Personal Profile
What is important TO Mary
about Health
and Safety?
ISP: Part II Personal Profile
Before the Annual
ISP Meeting
What if Mary also had asthma?
Outcome: Mary breathes easily.
Breathing easily. Using an inhaler each day.
Important TO Important FOR
Based on what we know about Mary, to resolve this outcome ask…
Can she develop a skill?
Can assistive technology be used?
Can natural supports be introduced?
Part III: Shared Planning
Can the condition improve?
Guiding questions
ISP: Part III Shared Planning
At the Annual ISP
Meeting
Outcomes needed to complete Shared Planning
1: The 5 required life areas2: The active medical and behavioral
needs outcomes3: The 3 standard outcome options
Part III: Shared PlanningISP: Part III Shared Planning
The 5 required life areas…
Work & Alternates to WorkLearning & Other Pursuits
Community & InterestsHome
Health & Safety
Part III: Shared PlanningISP: Part III Shared Planning
The “Active Needs” outcomes…
MedicalBehavioral
Communication
Sensory needs
Fall risk
Psychiatric needs
DiabetesHeart conditions
Causing harm
Hurting oneself
Taking from others
Part III: Shared PlanningISP: Part III Shared Planning
The 3 standard outcome options…
Routine health and safetyPeriodic Supports
Support Coordination
Steve is healthy, safe and a valued member of his community.
Steve has something to do when plans are cancelled.
Steve’s outcomes are achieved.
Part III: Shared PlanningISP: Part III Shared Planning
Slide 57
Steve is not tired all the time due to diabetes.
Steve explores different ways to enjoy music.
Steve has more friends.
Steve is healthy, safe and a valued member of his community.
Steve has something to do when plans are cancelled.
Steve’s outcomes are achieved.
Steve is organized.
Part III: Shared Planning
Steve has his own business and makes more money.
Active Medical/Behavioral?
5 required life areas?3 standard outcome
options?
ISP: Part III Shared Planning
Reflect that the current residential setting was the individual’s choice and is integrated in, and supportive of full access of the individual to the greater community.
CMS PlanRequirements
• Offers informed choices about services and providers;
• Records alternate HCBS settings considered;
• Provides confirmation that the setting is chosen by the individual.
CMS ProcessRequirements
Part I: The Essential Information
The Plan for Self-Sufficiency
Considers future plans for inclusion;
Replaces “discharge plan” in the ISP;
Applies to every individual.
ISP: Part I Essential Information
Before the Annual
ISP Meeting
Part I: The Essential Information
Steve
ISP: Part I Essential Information
Before the Annual
ISP Meeting
Document that any modifications to compliance with the HCB settings requirements for provider owned/operated residential settings are supported by a specific assessed need and justified in the PCSP…
CMS PlanRequirements
1. Individualized assessed need. 2. Previous positive interventions and supports.3. Less intrusive methods. 4. A clear description of the condition. 5. Collection and review of data (for efficacy).6. Time limits for periodic reviews.7. Informed consent of the individual. 8. Assurance that supports will cause no harm.
CMS PlanRequirements
Per the Office of Human Rights the record should show:
• the medication prescribed, to include dosage;
• an acknowledgement, if appropriate, that theindividual/decision-maker was made aware of the risk/benefits/side effects by the prescribing physician;
• contact information for the prescribing physician for any further questions;
• the signature of individual and/or decision-maker.
Psychotropic Medication Use
• Be distributed to the individual and others involved in the PCSP.
CMS PlanRequirements
• Identify the individual and/or entity responsible for monitoring the plan.
The PCSP must be reviewed and revised upon reassessment of functional need at least once every 12 months, OR when the individual’s circumstances/needs change, OR at the request of the individual.
CMS PlanRequirements
Slide 83
Contacts and resources:Community Resource Consultants (PC ISP): http://www.dbhds.virginia.gov/professionals-and-service-providers/developmental-disability-services-for-providers/provider-development
Person-Centered Thinking Training: http://www.personcenteredpractices.org/
Settlement Agreement information at DBHDS:http://www.dbhds.virginia.gov/individuals-and-families/developmental-disabilities/doj-settlement-agreement
CMS Final Rule information at DMAS: http://www.dmas.virginia.gov/Content_pgs/HCBS.aspx