DDD Town Hall Webinar Questions and Answers from 12-1-16

Table of Contents

  1. Opening Remarks
  2. Employment First Presentation
  3. Short-term Stabilization Homes (SSH) Presentation
  4. Life Choices/BQM Review Procedures Presentation
  5. Waiver Renewal Presentation
  6. General Questions

Opening Remarks

  1. You stated the national Community Integrated Living Arrangement (CILA) average is below 4 persons. What is the national rate of reimbursement/funding per CILA individual and where does Illinois rank in this average?
    • Answer:  We have contacted the National Association of State Directors of Developmental Disabilities Services (NASDDDS) who were unable to provide data. We will continue to explore this issue with other national organizations.
  2. What specific programmatic or funding changes is DDD planning or proposing to address the crisis in care highlighted in the Tribune series, most especially the increasing difficulty in hiring and retaining DSPs?
    • Answer: The Division of Developmental Disabilities (DDD) has initiated a number of steps to address the concerns highlighted in the Tribune series. Plans include the establishment of a unit dedicated to the review and analysis of critical incidents within the DD system and the development of a unit focused on providing technical assistance to providers. While these processes have been present to a limited degree within the Division, we will expand the resources available and address concerns in a more systemic manner.
    • The Division continues to recognize that Direct Support Personnel (DSPs) are the backbone of our service system and acknowledge that a stable work force is critical to the success of community programs. Division leadership continues to explore options for increasing funding for these positions as well as methods of identifying and addressing other factors that impact the recruitment and retention of these essential services.
  3. What are the public officials on this call doing to move Illinois from 45 (at best) to a respectable place in terms of funding? When do they plan to take responsibility for this disaster?
    • Answer: Again, we will continue to work with our stakeholders to address concerns about the community infrastructure. We recognize that we will need to continue our efforts to strengthen our services in the community.
    • In regards to funding, there are strategies in place to move services from the high end programs and create some savings in those areas. We can reinvest the savings in community infrastructure and give providers the incentive to expand their programs.
    • To address the other part of the question, as Division Director, I have taken full responsibility from the first day I started. We, including the senior Division staff, take our responsibilities very seriously. We commit ourselves every day to provide and improve the quality of services we offer to the people we serve.

Employment First Presentation

  1. How does the Employment First Initiative compare to the standard Division of Rehabilitation Services (DRS) employment packet?
    • Answer: The Employment First Initiative is a one-time project that has two components. The first is a best-practice study which will determine the most effective ways to help an individual achieve employment. The second part focuses on assisting 200 individuals to achieve competitive integrated employment.
    • Employment First providers are paid based on meeting four different milestones (enrollment, job development, job placement, job retention) while DRS payments are solely based on the one milestone of job placement.

Short-term Stabilization Homes (SSH) Presentation

  1. What is the current census in each of the Short-term Stabilization Homes (SSH)?
    • Answer: At the time of the Town Hall Meeting on December 1, 2016 there were seven persons being served in the two Chicago area homes (4 women and 3 men). In the Springfield area homes, there were a total of six persons being served (3 women and 3 men).
  2. What is the SSH intake process?
    • Answer:  The Division's Bureau of Community Services receives referrals from the Independent Service Coordination (ISC) agencies. Division staff selects a person based on criteria such as need and availability. The Division forwards the developed referral to the SSH Liaison. The SSH Liaison then works with the agency and/or guardian to coordinate admission.
  3. Are Short-term Stabilization Homes only for people who have the residential waiver?
    • Answer: No, the SSH program is for any adult (18 or older) with an intellectual or developmental disability regardless of service status.
  4. Does the Support Service Team (SST)/SSH have psychiatric specialists or psychopharmacologists to provide consultation?
    • Answer:  The SST program has psychopharmacologists available for consultation for individuals who are a part of the SST program. Each of the two SSH providers maintains a partnership with a local psychiatric service provider for consultation services.
  5. How many individuals are being discussed for SSH or waiting for availability?
    • Answer:  At the time of the Town Hall Meeting on December 1, 2016 there was a waiting list of approximately ten individuals. All ten individuals were receiving ongoing support from SST.
  6. What happens to the person who has been discharged from an SSH environment and shortly after, engages in the same behavior that prompted the first admission? Does the person return to the SSH home?
    • Answer: The person may return to the SSH but where the person goes and the type of services they receive will be determined after assessments are completed on a case by case basis.
  7. If they are not stable after 90 days, what happens?
    • Answer: The individual has the potential to stay longer, to go to a different provider or some other arrangement if it is decided the SSH is not enough for the individual. Short and long term plans are determined on a case by case basis and all available resources are considered.

Life Choices/BQM Review Procedures Presentation

  1. I am wondering what the Service Facilitator's role will look like in terms of home visits, etc. as of July 1, 2017?
    • Answer: The Service Facilitator's role will no longer include home visits as they are conducted now. The only home visits for the purpose of monitoring will be conducted by the Independent Service Coordinators and, on a sample basis, by State staff. The new definition for Service Facilitation, which has been verbally approved by CMS, is as follows:
      • Service Facilitation assists the participant (or the participant's family or representative, as appropriate) in arranging for, directing and managing services. Practical skills training is offered to enable families and participants to independently direct and manage waiver services.
      • Examples of skills training include providing information on recruiting and hiring personal support workers, managing workers, and providing information on effective communication and problem-solving.
      • The service/function includes providing information to ensure that participants understand the responsibilities involved with directing their services. The extent of the assistance furnished to the participant or family is specified in the service plan. The service does not duplicate other waiver services or Individual Service and Support Advocacy (ISSA) services provided by ISC agencies.
  2. Will there be a designated form for families to sign confirming they are locking into Service Facilitator for the year?
    • Answer: No, federal CMS has made it clear that we cannot require individuals and families to purchase a service. We have submitted an action plan to CMS that allows Service Facilitation to continue through June 30, 2017, as it exists now in order to phase in the new policies and processes. CMS recognizes that we cannot make the change abruptly. But as of July 1, 2017, Service Facilitation will be optional, and if purchased, there will not be a minimum amount required.
  3. What is going to happen to the Home-Based Support Services Program (HBS) for individuals with mental illness being as some facilitators still have clients in that program? Will that be optional too? What will happen to those clients if there are no facilitators?
    • Answer: The HBS Program for persons with mental illness is not part of the DD Waivers. The changes underway in the DD Waivers do not impact the mental health program.
  4. If the Developmental Training-Day Program (DT) funding is not changing and the QIDPs may be needed at the DT provider's site (which they will be), where will the funding come from to pay for the extra ISC duties?
    • Answer: When ISCs assume responsibilities for development and monitoring of the Personal Plan, it will be done within the hours currently allocated for each individual receiving waiver services. When ISCs find that those allocated hours are not sufficient to accomplish all needed activities for a specific individual, there is a process through which they may request authorization for additional hours of service. Careful consideration is being given to the many duties which are currently assigned to the ISCs and where possible, non-essential activities will be removed.
  5. Will the ISC QIDP also be completing the behavior programming for the individual and incorporating it within the Personal Plan?
    • Answer: The ISC will identify the broader behavioral supports the person needs but it will be up to the provider agency to identify and implement the behavioral strategies.
  6. Who will complete Service Authorization and Agreements? Will the forms be adjusted? (The current form requires a Service Facilitator signature) Who will adjust Personal Support Worker's (PSW) hours if DT hours decrease monthly?
    • Answer: If the individual or family choose to retain Service Facilitation, the service facilitators will remain responsible for those tasks. If the individual or family do not retain Service Facilitation, the guardian or employer of record will be responsible for completing and signing the forms.
  7. Who will be responsible to complete all annual assessments that accompany the Individual Service Plan (ISP)?
    • Answer: Discussions are still underway regarding what assessments will be required to be done by ISCs and what assessments will be done by provider agencies. For those that continue to be required, there will be clear guidelines issued stating who will be completing them.
  8. Was there any discussion about finding a better assessment than the Inventory for Client and Agency Planning (ICAP)?
    • Answer: At this point, we do not foresee any changes to the ICAP.
  9. Will the state continue to fund QIDP services to providers when the ISC is writing the program plan?
    • Answer: We do not anticipate changing current rates based on the shift of case management from the provider to the ISC agencies.
  10. With the upcoming push for smaller CILAs, how will the Division of Developmental Disabilities assist providers in making these changes with the current staffing issues?
    • Answer: We recognize that the national trend is for smaller CILAs. We also recognize that we have to provide incentives for providers to make smaller CILAs available. Until we are able to do that, it will be unrealistic for us to expect providers to go from eight beds to four beds.
  11. What are we doing to get a rate increase for Intermediate Care Facilities (ICFs), since ICFs are tending to get more referrals for higher need residents that CILAs are refusing?
    • Answer: That is part of the ongoing discussion with rates. Our long term plan is to begin moving away from higher cost settings which will allow those savings to be utilized in other areas.
  12. How is it expected to know a client or respectfully serve them when home visits are no longer required and we will not see them often?
    • Answer: When Service Facilitation is chosen, Service Facilitators will still need to guide families to the correct service mix. How the Service Facilitation staff and the families communicate to determine the appropriate services will be tailored to fit the individual's circumstances and needs. Home visits are still possible, just no longer mandatory.
  13. What if there is a disagreement between the Provider and the ISC regarding what can be done by the provider or what is in the best interest of the client and put into the ISP?
    • Answer: The Personal Planning process will focus on outcomes that are identified by the person receiving services in collaboration with their guardian and family. The ISC will document those desired outcomes, assist in identifying the barriers that currently prevent the outcomes, and assist the individual/family to locate and select agencies that are willing and qualified to provide the needed supports. Before agreeing to provide services for a specific individual, the Provider will know the desired outcome of the waiver participant. The Provider can determine whether or not they are willing and able to provide the requested services. In the case that the Provider is not willing and able to provide services, the ISC will assist the waiver participant and his/her family to locate other qualified and willing Providers.
  14. Who will be responsible for assisting the clients and families with benefits such as; Medicaid, DHS funding etc.
    • Answer: The ISC will continue to be responsible for assisting and directing families with Medicaid and other benefits.
  15. Is there going to be another PUNS selection this fiscal year?
    • Answer: The Division continues to make progress in making its benchmarks for the Ligas Consent Decree. Another PUNS pull is likely this fiscal year; however, at this point we cannot forecast when it will occur.
  16. Has "reasonable pace" removing individuals from the waiting list been defined?
    • Answer: The Division is continuing to meet with all Ligas parties and discussions continue on the definition of reasonable pace but no firm definition has been reached as of yet.
  17. When will the Person-Centered Planning process training be made available?
    • Answer: Pilot training began for ISC agencies in January 2017. Watch the Scoop for training announcements this spring for additional ISCs, provider agencies and persons served/family members.
  18. If a family wishes to utilize Service Facilitation, can they use it just as needed and not regularly each month?
    • Answer: Service Facilitation will be an elective service and the family and the Service Facilitation agency will have an opportunity to work out their own agreement to establish the necessary level of supports.
  19. Are personal support workers required to complete progress notes in Home Based Support Services?
    • Answer: Personal Support Workers will have a responsibility to document the provision of services outlined in the implementation plan and to document the participant's response to those services. That documentation will be used by the ISC to evaluate progress towards achieving desired outcomes for the individual receiving waiver services. The specific method of documentation (i.e. progress notes, data sheets, or other methods) will be determined on a case-by-case basis with input from the person receiving services, the family, ISC, and Providers.
  20. Are the ISC's responsible for writing the ISP?
    • Answer: Currently, the providers are responsible for developing the ISP. Effective 7/1/17, the ISC is responsible for developing the Discovery Tool and the Personal Plan as the person's annual ISP is due. Each provider will be responsible for developing the Implementation Strategy.
  21. Will the DHS ISP Approval Checklist no longer be valid?
    • Answer: The Approval Checklist was initiated to provide some standardization across the state. With the move to the Personal Plan format as of July 1, 2017, a standard format is being adopted. The checklist will no longer be needed.
  22. Regarding the Service Facilitation, if the Service Facilitator is not doing home visits, how often will ISCs be in the home?
    • Answer: The Service Facilitator will no longer be required to conduct home visits. Although there may be circumstances around which the family agrees that the Service Facilitator needs to conduct a visit. There continues to be discussion regarding the minimum number of visits that will be required by the ISC agency. The ISC's emphasis will be to assess the implementation of the Personal Plan and will take action as necessary on an individual basis. Home visits can be a part of the assessment process.
  23. What changes will be made in licensing of CILA providers to assure that providers have the skills and appropriately trained staff and administration to serve the individuals that they are accepting?
    • Answer:  There are some discussions underway regarding Rules 115 and 119 that may eventually create changes in licensing, but no changes have been made at this time. Any changes to the Rules will not occur before 7/1/17.
  24. Will there be a need for monthly QIDP progress notes, or will the ISC complete those?
    • Answer: The Provider will need to document the progress of the outcomes identified in the Personal Plan but the specific method or frequency of that document has not been finalized. ISCs will document progress of the Personal Plan.
  25. As we complete Service Agreements and Authorizations for 2017, what is your recommendation of what we should tell families about upcoming changes in July 2017 for HBS Facilitation? Also, should we be dating the Service Authorization and Agreements just from 1/1/17 to 6/30/17?
    • Answer: Service Facilitators should refer to the new definition of Service Facilitation and make families aware of all the functions Service Facilitation will continue to offer. Service agreements and authorizations may be updated when the annual plan date arrives.
  26. Who will train the DSPs on the new ISPs?
    • Answer: The training will be conducted by provider agencies. Each Provider will be responsible for its part of the implementation of the Personal Plan. The Division of Developmental Disabilities will also offer general/overall training on the Person Centered Planning process and make these available to all.
  27. Will all plans and strategic plans be required to meet new regulation on July 1?
    • Answer: No, as current annual ISPs are due for update after July 1, 2017, the new process would be implemented at that time. It will take one full year for all persons receiving waiver services to have their Person Centered Planning process in place.
  28. If the agency's DSPs/PSWs are responsible for collecting data and running the goals, how will they be held responsible for giving that information to the ISC agencies so that the ISCs can make modifications to the goals when needed?
    • Answer: Provider agency staff should document progress towards outcomes on a monthly basis (minimum) and make documentation available to ISC staff during the ISC visits.
  29. Will there be a statewide ISP/Risk Assessment form provided to the ISCs or are ISCs responsible for their own ISP/Risk Assessment?
    • Answer: There will no longer be a separate risk assessment tool. The new process includes methods of identifying, documenting, and addressing risks as part of the Discovery Tool and the Personal Plan development by the ISC. Provider agencies will then use that information to identify specific strategies that will be used within the agency to address those risks.
  30. Is there an update from anyone there on the Workplace Investment Opportunity Act (WIOA) requirements and the role that the DRS will play?
    • Answer: DRS is changing the rules that pertain to Transition Services for students in high school. Supportive Employment will be 24 months instead of 18 months and Extended Services will be for "Youth with a Disability." For Blind Services, DRS can no longer count the Homemaker or Family worker as a successful employment closure. Collaboration continues between DDD and DRS that will ensure that DDD is in compliance with all new WIOA requirements.
    • DDD is working on issues that will allow individuals to complete the necessary steps more easily so that they can access supported employment through DDD.
  31. Given the extra responsibilities of the ISC agencies will hours increase to over 25 hours each year per person?
    • Answer: At this time, there is no plan to increase hours. Discussions between the Division and ISCs will continue on which tasks may no longer be needed, freeing up time to perform the newly required duties.
  32. Will the ISC still be completing ISSA notes, or will ISC's just be monitoring and noting on the ISP?
    • Answer: The ISCs will still be expected to complete ISSA notes on their visits. After July 1, 2017 there will be a new form. The purpose of the visit will be to monitor the progress toward the desired outcomes identified in the Personal Plan. The ISC is also expected to monitor the health, welfare and safety of persons served.
  33. How many people do we anticipate an ISC QIDP will have on their caseload?
    • Answer:  The Division is not going to prescribe a minimum or maximum number for a caseload. This decision is made by each ISC agency.
  34. Who would write the ISP and monitor the progress for a person who does not go to DT but uses their funding only for personal support?
    • Answer: The Personal Plan will be written and monitored by the ISCs. The Division's Bureau of Quality Management, through their sampling review process, will also have some monitoring responsibility. The expectation is that writing and monitoring the plan will no longer be part of Service Facilitation but rather part of the ISCs' responsibilities.
  35. When can CILA providers expect to see revisions of Rules 115, 116, and 119 to come into compliance with Federal guidelines?
    • Answer: The Division is working to complete the changes to Rules 115 and 119. Rule 116 is in the final review stages. In addition, training has started for Rule 116.
  36. What will the expectation be when a small rural provider cannot implement the plan due to a lack of community resources?
    • Answer: The individual and family can decide if the service needs and desired outcomes are greater than their geographic desires. The Division recognizes that there are service gaps in some areas and has dedicated staff to implement capacity building.

Waiver Renewal Presentation

  1. Is the information given specific only to the Children's Waiver or does it apply to the Adult Waiver as well?
    •  Answer: In regards to Service Facilitation, both Waivers are the same.
  2. How will providers know if they are in compliance with the waiver setting if they were not sampled?
    • Answer: The Bureau of Accreditation, Licensure and Certification (BALC) and the Bureau of Quality Management (BQM) will continue to make site visits until all providers are reviewed. In the meantime, continue to use the self-assessment survey guidelines to maintain compliance.
  3. How many sites were in the follow-up sample to determine compliance?
    • Answer:  387.

General Questions

  1. Will QIDP's be receiving Continuing Education Credits (CEUs) for participating in this webinar?
    • Answer:  There will be no CEUs for Town Hall meetings.
  2. Where can we find the handout or print off the PowerPoint for this webinar?