PBHThe Piedmont Cardinal Health Plan

And the The Innovations Waiver

A Demonstration PartnershipBy, PBH

The NC Division of Medical Assistance, andNC Division of Mental Health, Developmental

Disabilities and Substance Abuse Services

Presented by:Andrea Misenheimer

Director DD Clinical Care ManagementFebruary, 2006

In North Carolina…In North Carolina…• The Community System took

shape rapidly and randomly because it was driven less by clear policy, and more by funding streams and special interests, as well as local governmental priorities. The system was inefficient and change was needed.

The NC Legislator called for The NC Legislator called for extensive reextensive re--engineering of engineering of the local community system to the local community system to promote a more effective promote a more effective system of care through system system of care through system management.management.

How PBH implemented How PBH implemented System Reform…….System Reform…….

Piedmont Cardinal Health PlanPiedmont Cardinal Health Plan

After extensive planning and research, the Piedmont Cardinal Health Plan waivers,

1915 B/C concurrent

were submitted on July 7, 2004 approved by CMS October 7, 2004.

We went live on April 1, 2005!

The Goal of the Piedmont Demonstration Project

Is to demonstrate local/regional public management and coordination of a system of care that ensures efficient use of resources and optimal outcomes for the people who will be served.

PBH is the 3rd largest LME (Local Management Entity, ) in North Carolina (by population-657,107) and the largest multi-county LME.

The road map to change for the The road map to change for the DD Service SystemDD Service System

• Collaborative Assessment ProcessSupports Intensity Scale and Risk Assessment

• Comprehensive Life Planning/Person Centered Planning

• Expanded consumer involvement in budget development and management.

• Flexible funding that supports individualized service delivery.

The Piedmont The Piedmont Innovations Waiver…Innovations Waiver…

• 1915c Home and Community Based wavier

• First Independence Plus wavier approved in the state to support people with Developmental Disabilities

• Currently serves 440 persons with expansion in years 2 and 3

• Offers everyone served, the opportunity to direct their services

• All participants have Person Centered Plans and Individual Budgets

Innovations Services that Innovations Services that facilitate change:facilitate change:

• Community Transition: supports movement from institutions to enable people to have homes of their own.

• Individual Training and Education:supports the development of self-advocacy skills to facilitate people’s ability to participate in Individual Family Direction.

• Individual goods and services:provides flexibility for consumers in purchasing highly individualized items to reduce needs on formalized supports.

• Supported Employment services:reimburses job seeking in addition to training and supporting the person on the job to promote people’s ability to work.

Person Centered Person Centered PlanningPlanning

• Based on the information gathered from the Supports Intensity Scale and the Risk Assessment, a comprehensive Life Plan is developed.

• The Plan identifies the services and supports the person needs to live as independently as possible in the community.

Information and Training Opportunities

• Annual Orientation to Individual Family Direction during the ISP

• Caregiver Training and Education

• Individual Training and Education

Individual BudgetingIndividual BudgetingThe person becomes an

informed purchaser of their services and supports.

Innovations Budgeting Methodology…..

Any other request will go through the Clinical Advisory CommitteeEquipment and Home Modifications

Base Individual Budget

Base Budget Plus Add On’s equal the comprehensive Individual BudgetAdd On’s are only valid for the current Plan year.

At the end of the current plan the budget returns to the Base Amount

Medically Necessary Services and Supports are identified by

the Individual and Treatment Team are authorized in the Base Budget

Base Budget only contains Habilitation/Support Services

Unexpected Needs/Crisis Emergencies

Life Changes

Choice is the cornerstone Choice is the cornerstone of Service Designof Service Design

Individuals and families may choose:• To use a provider agency, or• To employ their own staff, or • A combination of these.

Have it your Have it your way…way…

Design of Design of Innovations Innovations Individual/Family DirectionIndividual/Family Direction

Support Brokerage

Pbh-Systems Manager

FinancialManagement

IndividualFamily

Representative

Support Coordinator

How do all the pieces fit How do all the pieces fit together.. Implementationtogether.. ImplementationSupport Coordinator• Assesses the Individual/Family Needs• Develops the Individual Support Plan• Obtains approval and service authorizationSupport Broker• Hands on assistance and training with

implementation issuesFinancial Manager• Processes employment paperwork• Background Checks• Billing and reporting for services• Tracking the Individual Budget expenditures

Risk Planning, Risk Planning, Emergency BackEmergency Back--Up PlansUp Plans•• Everyone has a back up plan using formal and Everyone has a back up plan using formal and

informal supportsinformal supports•• Employer knows who to contact and next steps Employer knows who to contact and next steps

if the back up plan does not workif the back up plan does not work•• Plans are tested quarterlyPlans are tested quarterly•• There are at least two levels of back up staffingThere are at least two levels of back up staffing•• The plan includes emergency responses to The plan includes emergency responses to

weather.weather.•• Risk assessment is completed with the annual Risk assessment is completed with the annual

plan and then updated as new Risks are plan and then updated as new Risks are Identified. Risk Protocols are developed to Identified. Risk Protocols are developed to address each identified risk.address each identified risk.

Keeping our eye on QualityKeeping our eye on Quality• Incident Management

Follows State RuleUniform for all Participants

• Performance IndicatorsCritical IncidentsLength of Time LOC Length of Time ISP approvalLength of Time Services ImplementationMovement from institutions

• SatisfactionEmployer of RecordFinancial ManagerSupport Broker

Systems of Quality Management Systems of Quality Management Individual Family DirectionIndividual Family Direction

Interdepartmental Monitoring Team

Employer of RecordSupport Broker

Financial Management

Support Coordinator

PBH Quality Management

What we may know in time…..

Supports Intensity Scale (SIS)Will Individual/ Family Direction make a difference in the types of support someone needs?

Risk AssessmentWill we see different issues or strategies to mitigate?

Consumer Partnerships: Consumer Partnerships: Everyone’s commitment to Everyone’s commitment to

QualityQuality

•Clinical Advisory•Client Rights

Committee•Consumer Family

Advisory Committee•Global CQI

The Innovations Waiver is The Innovations Waiver is an essential tool that we an essential tool that we will use in reshaping the will use in reshaping the

service system for persons service system for persons with Developmental with Developmental

Disabilities!Disabilities!