The DDD Scoop (4-21-17)

Helping Families. Supporting Communities. Empowering Individuals.

Welcome to the latest issue the DDD Scoop. First and foremost, and in response to recent questions about this newsletter, please be advised that if you aren't currently receiving the DDD Scoop directly - and would like to be on our mailing list - please let us know by dropping a line to Kathy Ward at Kathy.ward@illinois.gov. We are working to update our distribution lists and streamline the means with which we communicate to employees, providers, families, ISCs, and other stakeholders.

Update on IDHS Administrative Rules 116 and 508

First Notice posting was previously issued in June of 2016 for amendments to 59 Ill. Adm. Code 116 and 89 Ill. Adm. Code 508. These changes included the expansion of medications that can be delegated for administration by Direct Support Persons (DSPs), as well as measures to streamline procedures for nurses and DSPs. An amendment to Rule 508 was also posted addressing the applicability of that rule to the appeal and hearing process for revocation of Master Nurse Trainer Status.

Response letters to all individuals who submitted public comments were mailed by the Department on April 19, 2017. Modifications to the proposed Rule 116 amendment based on comments received have been completed. The Second Notices were filed with the Joint Committee on Administrative Rules (JCAR) on April 20, 2017. We are now in the 45-day Second Notice period. We anticipate that JCAR may include this item on its May meeting agenda, but are awaiting confirmation of that.

Clarification of Adult Waiver Projected Costs and Rates

As you may be aware, the renewal application for the Adult DDD Waiver is posted on the Department's website at http://www.dhs.state.il.us/page.aspx?item=45915. We understand from comments and questions received since the posting that there is some confusion about rates for covered services within the Waiver.

Some folks are looking at Appendix J, which includes a table for Cost Neutrality of the Waiver. That table includes an average cost per unit. Some commenters have noted that the estimated average cost per unit may be a few cents different, for example, than the current rate and are wondering if this signals a rate change. It does not. Please be aware that the amounts in this column of the table are not necessarily the State's rates for services. They reflect an estimated cost per unit based on historical spending, or in the case of new services, estimates of future spending as our spending allocation stands today. These figures should not be viewed as the official rates for each covered service.

All rates are posted at http://www.dhs.state.il.us/page.aspx?item=38992. We will keep you informed and follow public notice requirements for any future rate changes, including the establishment of new rates for new services.

We do appreciate the interest in the Waiver renewal application and encourage any stakeholder thoughts and questions throughout the renewal process, even though the official public comment period has ended.

Disability Survey

I want to remind Division employees that all IDHS staff have to complete the Disability Survey. All employees need to do is go to the website, login and either press skip or answer the questions. It only takes two minutes and is required by the Governor's Mandate and Public Act 96-0078.

There are 3,677 employees who have not yet completed the survey. The current compliance rate is 70.83% when the Illinois Department of Human Rights (IDHR) would like to see this number as close to 100% as possible. If employees do not have access to a computer/internet, leadership staff must make the necessary arrangements to ensure all employees can take the survey.

Visit this link and follow the instructions on the website.

http://www.illinois.gov/DisabilitySurvey

The survey needs to be completed by APRIL 28, 2017. Remember all staff have to do to comply with this survey is login and either (1) complete the survey by answering the questions, or (2) press "skip". Any questions, comments, issues or need for a hard copy of the survey should be directed to Bureau of Civil Affairs at (217) 524-7068 or emailed to Krista.Culbertson@illinois.gov.

Information Regarding Day Program Funding Issue for FY18

The Division is aware that some providers are concerned about a proposed change in our Adult Waiver Renewal Application regarding our rate and payment practices for day programs. As you may know, the current Adult Waiver states that the maximum number of billable hours for employment and day services is 1,100 per year. This maximum is based on the requirement that developmental training sites be open for services a minimum of five hours per day for 240 days per year, or a total of 1,200 per year. The State then calculated the hourly rate with an absentee factor so that the 1,200 per year could be billed in 1,100 hours. The same practice is used for other day programs.

While this practice originally worked well when the great majority of individuals were attending only site-based developmental training programs at one provider, it creates difficulties as we seek to encourage Waiver participants to consider employment and community integration opportunities during the traditional day hours - sometimes with multiple providers involved. Additionally, participants will be restricted if 100 of their annual day hours are tied up in absentee factors, and providers, too, could be negatively impacted by the number of hours when individuals change providers within a fiscal year. Further, this practice continually causes confusion for stakeholders in understanding the number of service hours that are actually calculated into the annual funding amount.

As such, in the Adult Waiver Renewal Application, submitted to the federal Centers for Medicare and Medicaid Services (CMS) on April 7, 2017, we are proposing a change in the methodology to allow for billing of 1,200 hours per year for any combination of day programs. While the hourly rate for Developmental Training will be reduced to accommodate this change, the annual amount of funding will remain the same; however, providers' revenue will reflect actual attendance.

Some providers are objecting to this change, indicating they would lose funding due to absenteeism. We believe, however, that in addition to simplifying the methodology, this change will promote greater flexibility in day activities for participants, including increased opportunities to participate in multiple types of employment and day services. The full 1,200 hours must be available to participants so they can choose among all types of day programs, including employment related services. We also want to emphasize that it is not our intent to reduce overall funding for day program opportunities, nor are we projecting a reduction in the Adult Waiver Renewal Application or in the Administration's proposed budget and spending plans. In fact, if a provider were serving an individual who is now receiving all of his or her day program hours for developmental training, and the individual next year choses to receive 900 hours of site-based developmental training, 200 hours of community access services, and 100 hours of group supported employment services from the same provider, that provider would, in fact, experience an increase in revenue.

During 2016, we appreciated the assistance of a workgroup of stakeholders providing input on Employment First issues and day program definitions and spending in general. The group was facilitated by a national consultant, bringing knowledge of other state's practices. We used much of the language developed by that group for the service definitions in the Adult Waiver Renewal Application. The workgroup also provided input on costs and suggested rate components and levels. While we are using that information with regard to the components of our methodology, without an increase in our overall spending authority, we are not able to adopt the rate levels the group proposed. We were forthright with the stakeholders during the meetings that we did not have any commitment for a budget increase at this point in time.

We hope this information provides a better understanding of the situation. We also wish to emphasize that this matter is still at the proposal stage, as we anticipate that we will receive technical assistance from federal CMS. While we did receive comments of concern from providers during the Waiver Application's public comment period, the commenters did not propose any solutions or alternatives. The Division is open to and would welcome other suggestions and possibilities. Please submit your ideas to DHS.DDDComments@Illinois.gov. As a reminder, the Adult Waiver Renewal Application is available on the Division's website at http://www.dhs.state.il.us/OneNetLibrary/27896/documents/Reta/ADULTDD04072017.pdf.

Personal Outcome Measures (POM) Corner

Outcome: People are Safe

Feeling safe and free from danger is important to all of us across all environments including home, work, neighborhood and community. Physical safety may be threatened by physical surroundings, other people or lack of supports.

Regulations and inspections ensure safety standards are met, so agencies follow regulations in place to ensure the safety of individuals and train staff on necessary components. Living, working and leisure environments need to be not only clean and sanitary, but also any toxic materials need to be handled securely.

Safety risks include actual or potential situations of abuse, neglect or exploitation, and agencies address these risks even when individuals may not recognize the danger.

However, typical environments contain reasonable amounts of risk and overprotection may prevent people from learning.

Questions: How does your agency anticipate, recognize and respond to safety issues? How does your agency provide support to keep individuals' environments clean and hazard free? How does your agency ensure that individuals who depend on others to identify and respond to emergencies have support and special equipment in order to anticipate, recognize and respond to safety concerns?

Reference: CQL The Council on Quality and Leadership Personal Outcome Measures Manual, Copyright 2005.

2016 NCI Staff Stability Survey Program

This is the first year that Illinois is participating in the NCI Staff Stability Survey. Links for the survey have been emailed to all agencies that employ DSPs and provide direct services to adults with developmental disabilities. This week, staff from the Division's Bureau of Quality Management is making calls to providers that have not yet responded to provide assistance in accessing the survey and to answer questions. If we haven't reached you yet, we will, or you can call us if you need assistance. Please contact Brittany Winders at 217-524-1598 or Brittany.Winders@illinois.gov if you have not received your email link to this survey. We've made good progress, thus far, but still have a way to go before the June 30 deadline. (See chart below.) Please help us get complete information about DSPs in Illinois by completing your survey! (Although DDD staff can view who has responded to the survey, we cannot view the information you have entered. The information you enter is confidential and will be combined with information from other providers.)

2016 NCI Staff Stability Survey

2016 NCI Staff Stability Survey Program

In order to further assist agencies in responding to this survey, a webinar has been planned for May 2, 2017 at 10:00 am. This session, presented by representatives from National Association of State Directors of Developmental Disabilities Services (NASDDDS) and Human Services Research Institute (HSRI), will provide an overview of the NCI Staff Stability Survey underway in Illinois for the first time. The session will cover the purpose of the survey and provide instructions for completion as well as offer a question and answer session. Representatives from Illinois' Department of Human Services' Division of Developmental Disabilities will be on hand to assist with information. Use the following link to register to reserve your seat for this webinar. (For those unable to participate in the live event, a recording of the webinar will be available on the IDHS website.) https://attendee.gotowebinar.com/register/7489036862170234114

On the Move

Tami Royer joined the Bureau of Program Development and Medicaid Administration as an Administrative Assistant on April 16. She has been with the state for over 33 years and has worked for several state agencies including Natural Resources, Department of Labor and Department of Revenue. She and her husband currently live in Springfield.

Mabley Developmental Center has a new Director. Joshua Humphrey joined the Division on April 10. Prior to joining Mabley, he served as the Administrator for an 80 bed Medicare and Medicaid private skilled nursing facility in Shreveport, Louisiana. He has also served as Director of Rehabilitation for a 180 bed skilled nursing facility with 50 Medicare beds. Josh is a Certified Nursing Facility Administrator and holds a Master of Science Degree in Occupational Therapy along with a Bachelor of Science Degree in Health and Physical Education. He and his family will be relocating to the Dixon area from Shreveport.

Also, Maria Moreno has rejoined the Division through the IDHS Volunteer Services Program where she is assisting staff with clerical needs and support in the Director's Office. She has been a volunteer with the Program since 2011, and we are glad to have her back.

Neila Krouse will be retiring from the Division at the end of the month. Her last official day of work is April 28. Neila began her state employment over 15 years ago and most recently has served as a Health Facilities Surveillance Nurse in the Bureau of Community Services where she reviews nursing requests in CILA packets and conducts nursing reviews at SNF-PEDs throughout the state. She plans to enjoy spending her retirement with her husband and traveling to see her children and grandchildren.

Finally, as previously noted, Jerry Stam's last day will be April 28, 2017. Jerry is retiring after serving the state in a number of roles for almost 30 years. Most recently he has served as the Deputy Director for State Operated Developmental Center Operations. Jerry's future plans undoubtedly include plenty of golf as well as spending more time with his wife, children and grandchildren.

We welcome Tami and Josh to the Division and welcome back Maria. At the same time, we thank Neila and Jerry for their service and wish them the best of everything in their retirement.

SODC Operations News

Choate Center - The Choate Center hosted its annual A.B.A.T.E. (A Brotherhood Aimed Toward Education) Easter Run on April 15. The A.B.A.T.E. organization provides hamburgers, hotdogs, chips and sodas for a facility picnic. The organization also brings gift bags for all the individuals and provides short motorcycle rides around the campus to any interested individual being served at the Center. A Rehabilitation staff member at the Center begins organizing this event a month ahead. The Rehabilitation Department prepares and organizes the food serving, activities and music provided for the day. A.B.A.T.E. has also purchased a swimming pool, basketball and volleyball set, stereo system for the gym and other pool toys.

Fox Center - Individuals served at Fox Center participated in an Easter Egg Hunt and an Easter-themed movie was screened in the auditorium on Easter.

Kiley Center - On April 13, nine trainees completed their orientation training and will begin their careers as Mental Health Technicians.

Ludeman Center - On April 9, the Parents and Friends of Ludeman Center sponsored the April Disc Jockey Dance in the gym. Approximately 149 individuals attended this event along with numerous parents, guardians and volunteer workers. Ice cream and soda pop were served during the event and Thomas Bjorklund, a professional DJ, orchestrated the music.

Ludeman Center - As a result of generous donations from Chicago's two major league baseball teams, individuals have been able to attend games on April 8 and 19. Individuals will also be attending games on April 22, 23 and 26.

Mabley Center - Special Olympics Track and Field activities are underway. Practices continue with 20 athletes participating this year. Athletes are in 50 and 100 meter runs, softball throw, 100 meter race walk, and standing long jump. The event will take place May 6, 2017 at Rockford Harlem High School.

Mabley Center - Individuals are always excited to participate in Mabley's annual Easter Egg Hunt. Plastic eggs filled with bite-sized candies were hidden throughout the Mabley campus.

Murray Center - Individuals were busy celebrating the Easter season. Persons from all the cottages joined in an "egg dyeing extravaganza" in the administration building activity room. Dozens of eggs were dyed that were enjoyed on Easter. In the afternoon, a center-wide egg hunt was held.

Shapiro Center - Kankakee County Training Center has accepted one individual for employment and another individual participated in interviews for potential employment.

Shapiro Center - Vocational Coordinators met to discuss community employment and shared ideas to improve programs at the Center. They continue to explore opportunities for individuals to be involved in community employment. The Vocational Resale Shop has been accepting donations for its Grand Opening on April 28.

On the road again

Finally, on Monday, April 17, 2017 I had the pleasure of visiting Community Support Systems in Teutopolis, IL. I had an opportunity to tour a number of day and residential programs, and I was pleasantly surprised to learn how many staff have been working for this agency for thirty years or longer. In fact, a number of employees are quickly approaching 40 years of service with Community Support Systems. In one day program, I met two ladies who spend a portion of their day engaged in art work. Their art work appears on greeting cards - which are sold - or their paintings are sold at local auctions. One painting of a horse sold for $1900 at a recent auction. I then met two ladies who are competitively employed with a company that sanitizes, packages and transports equipment that is used for cataract surgery throughout the country. Both ladies expressed how much they enjoyed their jobs, and it was apparent that both are well liked by their coworkers.

Throughout the tour, Executive Director Andy Kistler in his staff expressed their appreciation for being awarded the Employment First grant to increase the number of individuals with I/DD working in individualized, competitive integrated employment environments. We believe that the Employment First grant, along with the changes in rate and payment practices for day programs referenced above, will increase opportunities for people to be competitively employed. In the coming weeks, we will be announcing plans to facilitate ongoing discussions with stakeholders that will, hopefully, produce consensus on a responsible strategy for increasing opportunities for many more people to transition to competitive employment environments.

Have a great weekend!