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The Final HCBS Regs - Reinventing Quality · Importance of Case Management free of Conflict •...
Transcript of The Final HCBS Regs - Reinventing Quality · Importance of Case Management free of Conflict •...
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/
Facebook S.D.DepartmentOfHumanServices
Twitter SDHumanServices 20
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