The Final HCBS Regs

A New Opportunity for Change

Reinventing Quality Conference

Moving from the WHY to the HOW

August 1, 2016

Dan Lusk State DD Director

Topics of Conversation

An Opportunity for Change – True Integration

Importance of case management free of conflict

Drivers of system change – beyond compliance

Elements of an optimal system

Systems change implementation plan

Using data to support change

Transition plan efforts – non-residential

Supporting Families Efforts 2

An Opportunity for Change – True Integration

Final Home and Community Based Services regulations published in federal register January 2014, effective March 17, 2014

• Residential and non-residential settings • True community integration to same extent

those without disabilities and not receiving HCBS

• Requirement of Person Centered Planning

• Mandate for Conflict Free Case Management

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CMS requirements for eliminating conflict

1915(c): Regulations at 42 CFR 441.301(c)(1)(vi) • States are required to separate case

management (person-centered service plan development) from service

delivery functions.

• Conflict occurs not just if they are a provider but if the entity has an interest in a provider or if they are employed by a provider

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Importance of Case Management free of Conflict

• Engaging in high quality, person-centered planning keeps the full focus on the person and their outcomes

• Focus on community integration and employment outcomes

• Serve as a resource for individuals and families to help navigate the system

• Assist individuals to assess important to and important for

• It’s about “finding the right fit” for a person and their preferences rather than “fitting” the person into what the system provides

5 Artwork by Valorie Ahrendt

How does conflict arise in case management?

• Self-policing occurs when an agency or organization is charged with overseeing its own performance

• Puts the case manager in the difficult position of: • Assessing the performance of co-workers and colleagues within

the same agency • Potentially having to report concerns to their mutual supervisor or agency director • Focusing on supports provided by their employer Participants must be able to exercise full freedom of choice

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Drivers of System Change – Beyond Compliance

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Case management responsibilities: • Point of entry, no wrong door approach • Development of standardized ISP • Quality ongoing ISP monitoring • Focus on integrated, competitive employment • Addition of LifeCourse planning tools

• Life trajectory • Integrated Services and Supports • Employment trajectory

Elements of an Optimal System

Focus on Personal Outcomes

Increased Choice of

Case Managers

Robust oversight and monitoring of

supports and services

Access and face-to-face time with Case Managers

Person Centered Practices

Standardized ISP

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Systems Change Implementation Plan

• Be transparent, share adequate information, use data

• Engage self-advocates, families and providers

• Assess structure, state laws & rules, policy

• Create new rate structure

• Enroll new providers

• Prepare waiver amendment

• Develop transition process for participants

• Conduct Training

• Communicate progress frequently

http://dhs.sd.gov/dd/cfcm/

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Community Conversations Well Attended

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• Invite people to the conversation

• Community Conversation vs. Public Forum • Waiver amendment public comment • Host Self-Advocate & Family Focus Groups

• Take Action Flyer • What steps to take • What questions to ask

• Most importantly LISTEN

• Choice • Control • Independence • Access to community

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6% 8%

86%

Did you help make your service plan? (N=249)

No Maybe, not sure Yes

4% 9%

87%

Does your case manager/service coordinator ask you what you want?

(N=264) No Sometimes Yes

National Core Indicators Data

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National Core Indicators Data

40%

41%

19%

Did you choose or pick your case manager/service coordinator?

(N=271) No, Someone else chose

Case manager/service coordinator was assigned but s/he can request a change

Yes, chose

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Transition Plan Efforts – Non-Residential Settings

• Developing thorough assessment and validation process focusing on outcomes

• Assessing state administrative rules and policies

• Reframing waiver definitions • Promoting integration through Community Life Engagement

• Incentivizing integrated, competitive employment

• Supporting Families

• Community of Practice expansion state

• Transitioning from real estate to real integration

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Supporting South Dakota Families

• SELN State Work Plan - families asked for reliable information throughout the lifespan, especially regarding employment & benefits

• Working with partners and

stakeholders to build capacity in supporting families and strengthening relationships

• Understanding families needs change

along with major life changes

• LifeCourse tools will enhance person centered planning efforts

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Focus Areas in Supporting Families Initiative

Key Focus Areas in SD:

• Culture of integrated, competitive employment

• Role of Support Coordination / Case Management

• Shared or Companion Living • Technology

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The Power of Partnerships in Systems Change

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Supporting South Dakota Families

All individuals live within the context of a family

• Focus on supporting the entire family;

• Planning for future, creating vision;

• Changing course: employment, jobs, careers;

• Achieving a good life!

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Person Centered Planning for Supporting Families

• Person Centered Planning efforts began with CMS/NASDDDS Real Choice Systems Change Grant in 2008

• Enhancing PCP by supporting families with thoughtful process to create vision for the future

• Focus on specific stage in life while keeping an eye on the future

• Expanding PCT toolkit with LifeCourse & other tools • Life Trajectory • Employment Trajectory • Integrated Services and Supports

• Jaric’s story

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Person Centered Planning for Supporting Families

• Implementing standardized ISP • Incorporating life domains • Expanding PCT toolkit with LifeCourse tools

• New state administrative rules require

• Important to/for • Employment Planning • Utilization of PCT tools

• Enhancing & Monitoring Outcomes • SMART – State Quality Data • National Core Indicators Data • Council on Quality and Leadership POMs Data

The Final HCBS Regs Influence Positive Change

Contact Information

Dan J. Lusk South Dakota, DD Director

500 E. Capitol Ave. Pierre, SD 57501

Phone Number (605) 773-3438

CFCM Website http://dhs.sd.gov/dd/cfcm/

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