Person- Centered Planning. Community Employment. Community Membership. Priorities

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2 Person- Centered Planning Community Membership Community Employment Priorities

3 Stronger Connections Develop abilities Better Benefits Expand Natural Supports Individual Improved Health Targets Increased Self-Esteem Enhanced Quality of Life

4 April 1 Implementation Availability of Group Employment Supports, Individual Employment Supports, and Career Planning services Rate modifications for adult day services, including implementation of the behavior add-on, medical add-on, and the community integration add-on Availability of Money Management services Budget limitation increases (Adult day array and NMT) Community inclusion- personal care hour units change to fifteen minute units and removal of service limitations Modification to Employment First Rule

5 Adult Day Support 5123: Non-Medical Transportation 5123: Vocational Habilitation 5123: Individual Employment Supports 5123: Career Planning 5123: Adult Day and Employment Group Employment Supports 5123: Services

6 Rate Modifications: Behavioral Support Medical Assistance Community Integration No change in base rate, include rate modifications Modified Clear outcome statement and expected activities Adult Day Supports 5123: Flexibility of stafffactor in needs of person, setting, and outcomes Must comply w/hcbs Settings Rule

7 Foster skill development Develop and enhance social connections Outcome Build community membership Adult Day Supports Expand personal choice Enhance Independence

8 Rate Modifications: Behavioral Support Medical Assistance Community Integration Time limited No change in base rate, include rate modifications Modified Vocational Flexibility of staff factor in needs of person, setting, and outcomes Clear outcome statement and expected activities Habilitation Must comply with HCBS Settings Rule 5123:2-9-14

9 Enhance understanding of interests, skills, priorities, and abilities Advancement on the Path to Community Employment Outcome Develop general work skills Vocational Habilitation Services expected to occur over a defined period of time Person- Centered Outcomes Achievement of competitive, integrated employment

10 Competitive Integrated Employment Part-time or full-time work in an integrated setting for which that person is compensated, eligible for benefits provided to other employees, and presented with advancement opportunities.

11 Rate Modifications ONLY APPLY TO UNIT-BASED: Behavioral Support Medical Assistance New 1:1 Services lead to employment and/or career advancement Career Planning 5123: Unit-based reimburseme nt Outcome-based reimbursement

12 What is Career Planning?

13 9 Components of Career Planning Worksite Accessibility Observational Assessment Benefits Education and Analysis Self- Employment Launch Components Career Discovery Job Development Employment/ Self-Employment Plan Career Exploration Assistive Technology Assessment

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15 Rate Modifications: Behavioral Support Medical Assistance base rate of SEenclave, include rate modifications New Clear outcome statement and expected activities Group Employment Supports 5123: Flexibility of stafffactor in needs of person, setting, and outcomes Must comply w/hcbs Settings Rule

16 Advancement on the Path to Community Employment Services expected to occur over a defined period of time Outcome Enhanced skill development Group Employment Supports Person- Centered Outcomes Achievement of competitive, integrated employment

17 Rate Modifications: Behavioral Support Medical Assistance New Services maintain/stabilize community employment Replaces SE- Community and Integrated Employment Individual Employment Supports 5123: Unit-based reimbursement 1:1

18 Individual Employment Supports Job coaching Sustained competitive, integrated employment Personal care, can be included but can not be the entire service Services Training in AT or other technology Outcome Workplace support Person- Centered Outcomes

19 Community Integration Rate Modification Providers of Adult Day Support and/or Vocational Habilitation may elect to receive the Community Integration add-on through when the following criteria are met: The staff delivering the service has completed department-provided competency-based training; The service is delivered in integrated settings; and The service is provided in groups of four or fewer individuals County boards will submit PAWS plans with the community integration procedure code for individuals with providers who elect to receive this add-on. ONDEMAND training is available at DODD My Learning:

20 Rate Modifications Behavioral Support Rate Modification (.63) Medical Assistance Rate Modification (.12) Community Integration (.52) See proposed rule at for outlined criteria for rate modifications

21 Budget Limitations Increase AAI budget limitation- 260 days of service CODB Category Group A Group A- 1 Group B Group C 1 $10,270 $10,270 $18,460 $30,745 2 $10,335 $10,335 $18,655 $31,070 3 $10,465 $10,465 $18,850 $31,395 4 $10,595 $10,595 $19,045 $31,720 5 $10,660 $10,660 $19,240 $32,045 6 $10,790 $10,790 $19,435 $32,370 7 $10,920 $10,920 $19,630 $32,630 8 $10,985 $10,985 $19,760 $32,955 Apply to adult day, career planning, group employment supports, individual employment supports, and vocational habilitation Proposed increase to NMT budgets to account for 260 days

22 Employment First 5123:

23 Timeline for HCBS Adult Day Waiver Redesign July 2016-April 2017 Training Webinars will be available regarding HCBS Adult Day waiver redesign starting in July Full timeline is available at All webinars will be archived at the link above. CMS approval obtained 2/22/2017. Technical Assistance Live Chats resumed this month and will continue monthly. Immediate questions can be directed to Citations April 2017-October 2017 November 1, 2017 ongoing May 31, 2018 ongoing No citations unless action/activity would also have been a violation of previous rules Citations when there is substantial non-compliance Citations when there is substantial non-compliance

24 Timeline for HCBS Adult Day Waiver Redesign Annual Reviews/Renewals of Plans April October 2017 November 1, 2017 ongoing May 31, 2018 ongoing Encouraged to follow new rule. At the time of annual review, plans ALL PLANS SHOULD BE IN must be updated. COMPLIANCE Funding: As long as the plan indicates the types of service authorized and the provider submits a claim for those services that does not exceed the authorized amount, payment will be provided, even if the ISP doesn t include person-centered outcomes that coincide with the service definition. Funding: As long as the plan indicates the types of service authorized and the provider submits a claim for those services that does not exceed the authorized amount, payment will be provided, even if the ISP doesn t include person-centered outcomes that coincide with the service definition. It is expected at the time of annual review, plans will be updated. New Plans Encouraged to follow new rule Should be in compliance with new rule Funding: Plans are encouraged to follow new rule to ensure personcentered outcomes coincide with the new service definition Funding: Plans should be in compliance with new rule to ensure personcentered outcomes coincide with the new service definition.