Mission

Possib

le

Septem

ber 26, 2

013

M I K E W I L L D E ND I R E C T O R , N E VA D A D E PA RT M E N T O F H E A LT H A N D H U M A N S E R V I C E S

ADSD LEGISLATIVE APPROVED TOTAL REVENUE

2006-07 2008-09 2010-11 2012-13 2014-15$0.0

$100.0

$200.0

$300.0

$400.0

$500.0

$600.0

$76.8 $83.9$130.3 $108.9

$494.2

Biennium

Mill

ions

2

ADSD LEGISLATIVE APPROVED GENERAL FUND

2006-07 2008-09 2010-11 2012-13 2014-15$0.0

$50.0

$100.0

$150.0

$200.0

$250.0

$300.0

$20.4 $22.1$45.4

$29.9

$242.6

Biennium

Mill

ions

3

ADSD TIMELINE

2000 2001 2003 2005 2007 2009 2011 2013

Where have we been?

4

2000Olmstead Ruling Published• ADA prohibits states from

unnecessarily institutionalizing persons with disabilities.

• People should be serviced in the most integrated setting

5

2001 SessionStrategic Plan for People with Disabilities

Authorized by Legislature

• Number 1 in the Nation with Disabilities Growth (157% growth over prior decade)

• Lack of Integrated Services Available• Information Systems Lacking• Need to Expand Waivers/Community Options• Children Needing Services (Behavioral Health/Autism

called out)

6

Strategic Plan for Senior Services Authorized by Legislature

• Rapid Growth in Senior Population (56% over prior decade vs 35% general population)

• Information Systems Lacking• Need for more Community Services• Flat Funding of Services

7

2001 Session (continued)

2003 Session • General Fund $$ Added to Senior Rx Program ($2.8M) due

to Rapid Growth – Senior Rx Discount Program also authorized ($300K)

• Disability Rx Program Created (2.5% of Tobacco $$)• Office of Disability Services established in DHHS Director’s

Office transfer from DETR• Community Based Services and Developmental Disability

Budget transferred – goal to centralize services. • Facility oversight and Community Integration Services

(FOCUS) started in 2003.• Personal Care Services (PCS) started as an expanded

state plan service in 2003.

8

2003 Session (continued)• AB 395 passed creating quality of nursing care account

(6% Provider Tax)• AB 164 passed imposing surcharge on telephone

access lines to provide telecommunication devices to persons with impaired speech or hearing.

• SB 174 passed transferring $1.1M from Aging Services to OCBS to fund personal care assistant service – finding that OCBS was not properly funded.

• Health Insurance for Work Advancement (HIWA) approved allowing Medicaid Coverage for employed disabled through a buy-in mechanism.

9

2005 Session• AB 524 passed to coordinate Senior Rx with Medicare

Part D Rx coverage effective January 1, 2006. Senior Rx converted from “insured” to “self-insured” model

• AB 284 passed establishing Assisted Living Waiver (7/1/06)

• Developmental Services initiated pilot program to provide assistive payments averaging $1,100/month to 52 children ages 2 – 10 diagnosed with mental retardation and autism. (TANF $$)

10

2007 Session• The final 20 remaining institutional beds at Sierra

Regional Center were eliminated in the budget – community crisis prevention/intervention teams authorized.

• AB 629 passed creating Nevada Autism Task Force and appropriated $2M in general funds for Autism Services

11

2009 Session• Legislature approved recommendation to consolidate the

Office of Disability Services (in DHHS Director’s Office) with Division of Aging Services – Division of Aging Services became Aging and Disability Services Division

• Developmental Disabilities, Community Based Services, and IDEA Part C Office were transferred.

• Senior Rx and Disability Rx were transferred from Healthy Nevada Fund to their own budget account in ADSD

• Legislature approves additional $3.2 M for autism services (above the $2M approved in 2007 session)

12

2011 Session• Developmental Disabilities Council/budget account

moved back to DHHS Director’s Office from ADSD – autonomy issue

• Senior Citizen’s Property Tax Assistance program was eliminated saving approximately $6M each year.

• Senior Medicare Patrol program was transferred from the Attorney General’s office to ADSD

• AB 345 passed establishing Autism Treatment Assistance Program (ATAP) as primary treatment program – funds transferred from MHDS self-directed autism program

13

2011 Session (continued)• EPS services addressed by Legislature as a result of

Clark County transferring EPS function to the State effective May 2010 – 15 new staff approved.

• Received Medicaid Money Follows the Person (MFP) Grant April 1, 2011 (runs thru 2016)

14

2013 Session• Alzheimer’s Task Force created (AB 80); and Respite Care Program

expanded (SB 86) for person’s with Alzheimer’s or dementia.• Nevada Early Intervention Services (NEIS) transferred from Health

Division to ADSD. IDEA Part C Office transferred to DHHS Director’s Office oversight.

• ATAP gets $11.7M biennium budget (GF and Tobacco $$)o FY 14 slots = 307o FY 15 slots = 572

• Regional Center budgets (3) and Family Preservation Program budget are transferred from MHDS to ADSD

• DRC receives 52 new staff to support caseload growth and individuals requiring intensive behavioral support -- $24.4M added to budget

15

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

2530

2723

3083

34443763

4008 40704265 4340 4212

44784265

3947

4355

2842

25072777

3060 3047 3048 3111 3120 3140 3158 31492870 2929 2908

Home and Community Based Waiver and

Nursing Facility RecipientsAverage Recipient Count by State Fiscal Year

HCBW Linear (HCBW) Institutional Linear (Institutional)

Reci

pien

ts

September 19, 2013

All statistics are estimates and must be referred to as such whether used verbally or in written form.

16

FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 2012 FY 20130

1,000

2,000

3,000

4,000

5,000

6,000

7,000

198451

809

1,298

2,611

3,293

3,818

4,3054,728

4,9775,221

5,481

5,385 5,427

Continuum of Care Provider Type 30 Personal Care Services and Provider Type 83 Intermediary Service Organization

Average Recipients by Fiscal Year

FISCAL YEAR

RECIPIENTS

Recipients counted once if they received any services from PT 30 and/or 83 providers. All statistics are estimates only and must be qualified as such if used either verbally or in written form.

September 19, 2013

17

Waivers FY14/15Waivers FY14

SlotsFY15 Slots

Home & Community Based Waiver (HCBW) /Frail Elderly/CHIP-- started 7/1/87-- combines Waiver for the Elderly in Adult Residential Care (WEARC) and Community Based Initiatives Program (CHIP waiver)

1,771 1,830

Waiver for Elderly in Adult Residential Care-- started 7/1/98-- merged with HCBW 7/1/11

N/A N/A

Assisted Living Waiver (AL)-- started 7/1/06 54 54

Waiver for Persons with Physical Disabilities (WIN)-- started 10/1/89 670 754

Mental Retardation/Developmental Disabilities Waiver (MRRC)-- started 10/1/82

1,820 1,945

Community Options Program for the Elderly (COPE) 59 61

18

Autism FundingGovernor Rec. Leg Approved

FY11 FY12 FY13 FY14 FY15 FY14 FY15

Actual Actual Budget Budget Budget Budget Budget

RevenueGeneral Fund

$1,885,987

$1,959,167 $1,272,459

$1,447,049 $2,780,854 $1,615,081 $3,005,355

Tobacco $1,182,612

$1,804,735 $2,229,543 $2,465,323 $4,648,516

Expenditures

ATAP $1,885,987

$1,959,167 $2,455,071

$3,251,784 $5,010,397 $4,080,404 $7,653,871

# Served 97* 136 136 236 341 304 583

Autism Treatment Assistance Program (ATAP) within Aging and Disability Services is the only program that has received funding specifically for autism services.*FY11 pilot program with one-shot funding19

Integration – What is Next?• Strategic Planning – develop next 5 – 10 year plan• Performance – Outcomes – Accountability• Develop Information Systems – collection of meaningful data• Make sure unique stakeholders are not lost in the process• Look for new funding sources/opportunities – Grants!• Combine Waivers (HCBW –AL- WIN)• Understand the new health care system – The ACA• Apply for/implement CMS Balancing Incentive Payment

Program (BIPP)

20