employment services for iowans with disabilities redesign update
TRANSCRIPT
Employment Services for Iowans with disabilities
Redesign Update
May 27, 2014
Iowa Community of Practice
Lin Nibbelink, Iowa DHS
Division of Mental Health & Disability Services
LeAnn Moskowitz,
Iowa Medicaid Enterprise
Changing the question to change the culture
From “Do you want to work?”
TO “What work do you want to do?”
Movement on the LandscapeChange is happening all across the nation Recent Findings by U.S. DOJ and Labor in Oregon, Rhode Island, and New Hampshire: segregated services violate the integration mandate of the ADA, and the U.S. Supreme Court’s “Olmstead” ruling “most integrated setting” requirementThe Centers for Medicare and Medicaid Services (CMS) issued guidance (Sept, 2011) describing expectations for pre-vocational services offered within sheltered workshops.Title 14(c) of the Fair Labor Standards Act is under review in the U.S. Congress. MHDS Redesign Core Services definitions and rules; Regions required to do “Evidence-based practices (EBP)”; Supported Employment is an EBP
Systems ChangeIowa has been working on Employment for people with
disabilities, for some time!
• 2005+ –Consumer workshops & Self Employment (MIG)
• 2009 –E1st focus groups and Summit (MIG)
– Joined State Employment Leadership Network (SELN)
• 2010 – SELN “Findings” Report
– MIG Pilot projects on Customized Employment
• 2011, 2012 – SELN researched other states, made recommendations, produced “Capacity Building”
report
– DOL ODEP EFSLMP grant awarded to IVRS
– DOL DEI grant awarded to IWD
• 2013 – Key Assumptions document
– Distilled the “Stakeholder Brief” document, used to kick off Community Conversations
During June 2013
Community Conversations in 5 places around Iowa, sought input from a broad range of stakeholders
In collaboration with Iowa Vocational Rehabilitation Services (IVRS), the Iowa DD Council, and the Iowa Coalition for Integrated Employment (ICIE); Facilitated by Dale Verstegen, TransCen; 152 people
Workgroup members auditioned and were selected to represent a balance of rural-suburban-urban, large and small providers, those who do only facility based services, those who do community based only, and those who do both
Workgroup Activities
30 participants representing parents, siblings, 14 provider agencies, case management, county & state funders
Intense all-day facilitated work meetings twice/month in Ames or Johnston, with homework in between
Employment service definitions: July 11 & 23
Provider requirements, staff qualifications, staff training: August 8 & 13
Reimbursement Methodologies: September 10 & September 26, October 8 & 31
Feedback Webinars - July 26, August 28, September 25
We are all working hard to craft system changes so individuals have an expanded array of choices for employment and wrap-around supports!
Recommended changes to:• Service definitions for:
Prevocational
Supported employment
Day habilitation
• Service provider standards and staff qualifications for all the above
• Medicaid rates, to support quality staff & quality services
SELN Sample Rate Model p.1
SELN Sample Rate Model p.2
For Rates, we landed on a combination of…
• Workgroup “Average” recommendations• Recommendations by national experts
(SELN, ODEP)• Salary ranges for comparable positions in
State government• Salary numbers based on provider time-
studies
Next Steps• Continue work to implement proposed changes• Keep working with SELN and ODEP experts to fine-tune
potential rate model • Keep working with IVRS & other partners• Continue cost-modeling out projections for
blending/braiding IVRS/DHS• Continue cost-modeling out long term projections• Apply sample models to current claims to estimate
impact• Draft Waiver Rules & invite comments from partners &
consumer advocacy community• Submit to CMS• Submit Report to Legislature per HF2463 (p.73, sec. 65)
What can you do?
• Join the Iowa Coalition for Integrated Employment, [email protected]
• Explore how your agency can be a part of the system redesign
• Ask how your agency’s business model today fits the funding realities of the future (Region, Medicaid, Managed Care, Other)
• Candidly express your fears and concerns, and offer solutions
• Continue asking questions
ResourcesMHDS Employment Website:http://dhs.iowa.gov/mhds/disability-services/employment
IVRS Website:http://www.ivrs.iowa.gov/
ODEP’s Employment First initiatives: http://www.dol.gov/odep/topics/EmploymentFirst.htm Lin Nibbelink, Email: [email protected] – MHDS,1305 E Walnut St., Des Moines IA 50319 PH: 515.281.3023 FAX: 515.242.6036
LeAnn Moskowitz, Email: [email protected] - IME, Bureau of Long Term Care100 Army Post Road, Des Moines, IA 50315PH: 515.256.4653 FAX: 515.725.1360