ACAP A program of Keystone Human Services and the Pennsylvania Department of Public Welfare

1. ACAP A program of Keystone Human Services and the Pennsylvania Department of Public Welfare Bureau of Autism Services ANCOR Fall Leadership Summit Robert J. Baker President/CEO, Keystone Autism Services rbaker@keystonehumanservices.org

2. ACAP is a fully integrated, comprehensive system of care for adults with Autism Spectrum Disorder (ASD). The program incorporates vocational, behavioral, social, health, recreational, transportation, therapeutic, educational, crisis, in-home support and independent living aspects of Participants’ lives.

3. Three Unique Characteristics: • Pre-paid Capitation Payment Approach • Healthcare Services Fully Integrated into the Model • Outcome Measures Agreed Upon and Placed in the Contract

4. PURPOSE: • The purpose of the ACAP program is to help adults with ASD to be valued and fully participating members of their society. • The program works to build competence, confidence and independence so people can, as much as possible, lead full and meaningful lives. • Over time, the program works to increase independent functioning and decrease the need for highly structured professional services.

5. ACAP PRINCIPLES: • Every person living with an Autism Spectrum Disorder (ASD) can experience a meaningful and quality life. • Every person with ASD can grow and learn for the entirety of their life. • Services are comprehensive, highly individualized, flexible and continuously adapted to the persons needs and preferences.

6. ACAP PRINCIPLES Con’t: • Services are community based and make maximum use of the capacity of the family, friends, neighbors and community at large. • Therapeutic strategies are evidence based and are carried out by a highly qualified clinical team. • The effectiveness of the program is continuously measured. • The program makes maximum use of innovation, creativity and technology to support successful functioning.

7. ACAP ELIGIBILITY: Be twenty-one (21) years old or older Be eligible for Medical Assistance Have a diagnosis of an Autism Spectrum Disorder (ASD) Be able to live in a community setting (such as the person’s home or other family-members) safely without 16 hours or more per day of awake staffing and supervision

8. ACAP SAMPLE SERVICES*: • Supported Employment • Physicians Services & Health Care • Dental Services • Behavioral Support Services • Service Planning & Supports Coordination • Respite • Recreation & Social

9. ACAP SAMPLE SERVICES con’t: • Crisis Intervention • Non-Medical Transportation • Family Counseling • Physical Therapy • Individual Counseling • In-home services *We are not locked into service definitions; can provide any medically necessary service.

10. ENROLLMENT PROCESS: • Referrals or individual applications go to the Bureau of Autism Services (BAS) • BAS does preliminary eligibility determination • Referral to Keystone – We do comprehensive assessment and gathering of baseline data • Propose ISP to Individual. They decide whether to enroll.

11. Person-Centered Planning: • Clinical assessments and the development of each person’s Individual Service Plan (ISP) is provided by a highly qualified internal team. • ACAP services are dynamic, having the capacity to vary intensity and an individualized response dependent upon current and/or changing needs. Services can be deployed in “real time”. • Services are designed to include meaningful community inclusion and promote independence and self sufficiency. • The person’s dreams and choices are core considerations in ACAP person-centered planning. • The family is a central resource and partner in all planning and progress.

12. ACAP meets the full range of defined needs when a person enrolls in the program. Services are assessment and outcome driven. (SIB-R) Authorizations are based upon medical necessity following a comprehensive clinical assessment and the development of individualized service plans. Clinical assessments are conducted by a highly skilled team of Masters level clinicians working under supervision of a Licensed Psychologist. ACAP is responsible for providing and/or arranging all services for Participants - doing so in a manner that assures effective service integration and continuity. Clinical Capacity:

13. Uses the federal Prepaid Inpatient Health Plan funding model used currently by The Office of Long Term Living. Funding consists of a single “per member per month” payment for the full array of program services. Rate determination is done yearly. Capitation Approach:

14. Outcome Measures: • Improvement in behavioral stability of the Participants as measured by: • 1. Fewer Episodes of: • Law Enforcement involvement • Psychiatric Emergency Room care • Psychiatric Inpatient Hospitalization • Crisis Intervention Plan use • Mental Health crisis interventions

15. Outcome Measures con’t: • Improvement in behavioral stability of the Participants as measured by: • 2. Increases in: • Percentage of Participants with jobs or engaging in volunteer work • Number of hours Participants work or are engaged in volunteer work • Participants’ independence and social skills • Parental satisfaction and quality of life indicators • Participant’s quality of life

16. Outcome Measures con’t: • Improvement in behavioral stability of the Participants as measured by: • Improvement in access to medical services including: • Initial visit with a PCP within three weeks of enrollment • Annual dental exams • Improved diabetes management • Annual gynecological exams

17. PreliminaryOutcome Results: • Decrease in frequency of incidents • Increase in work and volunteer participation • Increase in SIB-R scores- Independence and Social Skills • Increases in Participant’s Quality of Life Scores • Minor increases in Parental Satisfaction and Quality of Life scores

18. Financial Results: • Grant provided start-up support • Month 9 of the program was the first profitable month • Every month since has been profitable • Program reached Life to Date Profitability in month 13 • Start-up line of credit reached $747,578 • Positive cash position is now over $1,000,000

19. SAFEGUARDS: • Extensive and valid measurements of outcomes • Family advocates on governing board • Family advocates on Plan Advisory committee • Bureau of Autism Services clinical team reviews all ISPs • Comprehensive reporting of all incidents • Easy external appeal to BAS

20. SAFEGUARDS Con’t: • Extensive quality system • Highly credentialed clinical team • Extensive family communication • Family advocate • Annual cost report and review of rate • Right to transfer to Adult Autism Waiver

21. Uniqueness of the Model: One Agency Responsible-One Agency Accountable Comprehensive services Full Coordination and Integration of Services Inclusion of Health Care Services Person Centered Dis-intermediated Fully integrates risk and service delivery

22. BROAD APPLICABILITY: The ACAP model is fully approved by CMS and has broad applicability to autism, intellectual disabilities, behavioral health, aging, children and youth and criminal justice services

23. FEE FOR SERVICE PARADIGM: Fee for service (focus on human service widgets) Compliance focus on unit of service, claims & process Highly defined service codes (commodities) Individual need must accommodate authorized services Utilization driven incentives Highly structured service models Exclusion of natural capacity of community and family

24. FEE FOR SERVICE PARADIGM con’t: Exclusion of technology and innovation Complex systems, regulation and licensing demands Very expensive infrastructure Rigid structures and processes External case management and authorizations Minimal integration across service models and need Authorized service may have no relevance to need

25. EMERGENT HUMAN SERVICE PARADIGM: Focus on the person, not human service widgets Capitated funding – aligning risk and authority to manage service resources Comprehensive services and supports Flexible and responsive Highly Individualized Compliance focus on outcomes not claims No service codes Highly credentialed clinical staff & effective clinical models

26. EMERGENT HUMAN SERVICE PARADIGM con’t: Focus on growth and capacity building vs. utilization Dynamic deployment of resources as people’s needs change Extensive range of service models Extensive use of natural capacity of community and family Extensive use of technology and continuous innovation Moderate infrastructure cost Highly integrated across service systems and needs Cost reporting and limit on profits

27. PUBLIC POLICY BENEFITS (ACAP): The Department of Public Welfare knows its exact financial liability at the beginning of the fiscal year. The Provider is responsible for all changes in need during the year. The model makes effective use of public resources. The ACAP model provides relevant, valid and reliable outcome data on performance. The ACAP model has the potential for extensive costs savings.

28. PUBLIC POLICY BENEFITS con’t: The model caps (retention) profits at a level appropriate to public policy interests. The model supports innovation and use of technology. The model incurs no intermediary (middleman) administrative costs and intermediary profits. The model has high accountability and transparency. The model is applicable to a wide range of services to include intellectual disabilities, behavioral health, aging and criminal justice.