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Service and Support Administration: The Rule Kelly Miller and Jean Tuller

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  1. Service and Support Administration: The Rule Kelly Miller and Jean Tuller Ohio, 2014

  2. Why Are You Here? No, really, why are you here… • Share three reasons why you have stayed in the field. • Where do you spend the majority of your day? • What are you doing there? • What do you think about that?

  3. What have we learned? • Too much emphasis on paper and process • Overly detailed monitoring plans • Confused monitoring services and compliance of providers • Believed we could not help individuals select a provider

  4. What’s different? • Monitoring is individualized • Responsibility of a team • Natural supports important • Person drives the supports

  5. What’s different? • Ensures providers are trained on service plan expectations • Providers receive plan 15 days prior to implementation • Outlines specific areas to assess • Individual leads Person-Centered Planning process

  6. 42 CFR 441.301

  7. Language from the rule • “Primary point of coordination” instead of “single point of accountability”. • Team: • People involved with plan development or implementation • Guardian or representative • Specialists or experts • Anyone the individual chooses

  8. Language from the rule • Decision Making Responsibility • An individual cannot act as their own guardian (if guardianship has been deemed necessary) • Addresses “best interest of the individual” • It draws a bright line between representation and financial interest • It affirms the primacy of “the individual's needs, desires and preferences.”

  9. Language from the rule • Provision of Service and Support Administration • Service and Support Administration provided to: • Waiver recipients • Individuals 3 years or older and eligible for county board services (if requested) • Individuals residing in ICFDD (if requested)

  10. Language from the rule Provision of Service and Support Administration Service and support administration must be provided in accordance with the requirements of section 5126.15 of the Revised Code. *There is no waiting list for service and support administration.

  11. Language from the rule • Primary Point of Coordination • Responsibilities: • Establish individual budget • Objectively facilitate provider selection process • Assist individual as necessary to resolve concerns/conflicts with providers

  12. Language from the rule • SSA Responsibilities: • Review and revise service plan at least annually and more often as needed. • Plans may need to be revised more often due to: • Identified MUI/UI trends and patterns • Change in living situation • Change in medical condition

  13. Language from the rule • SSA Responsibilities: • Explain to waiver enrollees, including: • Alternative services available • Due process /appeal rights • Free choice of provider/ provider selection process • Freedom of choice (waiver vs. ICFDD) • Services and supports funded by waivers

  14. Language from the rule • SSA Responsibilities: • Implement a continuous review process: • Tailored to the individual • Scope, type and frequency of reviews specified in service plan • That ensures that service plans are developed in accordance with this Rule

  15. Language from the rule • Frequency of continuous reviews may increase due to: • Intense behavioral or medical needs • Interruption of services more than 30 calendar days • Crisis or multiple less serious but destabilizing events within a 3 month period • Transition from ICFDD to community setting within past 12 months

  16. Language from the rule • Frequency of continuous reviews may increase due to: • Transition to a new waiver provider in the past 12 months • Individual’s provider is being suspended or revoked • Request by the individual, guardian or adult identified by the individual

  17. Language from the rule • SSA needs to share the results of the continuous reviews with team members as appropriate. • If identified areas of non-compliance with waiver provider: • County board conducts a provider compliance review or can request DODD to do so

  18. Primary Point of Coordination The Zen of DD- Everything is related to everything else.

  19. Ohio’s ISP System The person and their circle The ISP Team Anyone on ISP Team The ISP Team Gather person centered information Establish a budget Keep the plan relevant Discuss and make decisions Assessment Individual Service Plan Individual Service Plan Revisions

  20. Assessments: Cuyahoga County Methodology Discovery of the person (assessment) is discussed as a function of conversation. SA’s practice the art of conversation to facilitate discovery – the challenge is to NOT read down the list of questions in each topic area of the ISP assessment but rather, to engage in conversationand listen to stories. Then, record informationon the assessment template.

  21. Importantto/Important for • Gives people a structure to works towards a balance between what’s important to someone and what’s important for them • Useful for thinking through a situation before deciding what happens next. 2 4 Important to Important for

  22. Important to/Important for 2 4 Important to Important for

  23. Important to/Important for

  24. Risk Management • Do I have adequate health care? • Do staff know how to support my health and safety? • Are my home and work place safe, secure, clean and well maintained? If I own or rent a home, have decisions about safety features been informed and freely made? • Are my belongings secured at home and at work?

  25. Risk Management • Can I get help in emergencies or dangerous situations? Do I need education and supports in this area? • Do I know how to report mistreatment? Are education and supports necessary to assist with this? • Are there safeguards to ensure that I am free from abuse, neglect and mistreatment? • Do I manage my own finances? Do I need education and supports in this area? If I cannot manage my own finances, are there safeguards to protect my resources?

  26. Risk Management • Are you reviewing the person’s health and welfare for risk of: • Aspiration/choking? • Dehydration? • Constipation? • Seizures? • Specific health and medical concerns (e.g., diabetes, complications associated with a feeding tube, unable to clearly report pain, injuries due to falling)? • Behavioral issues and supervision needs

  27. Employment FIRST • Where do I spend my weekdays? • Would I like a greater variety of activities? • What new skills would I like to master? • Do I like the people I work with or spend my time with during the day?

  28. Employment FIRST • Would I like a job or a different job? • What am I proud of at work? • What do I enjoy doing? • What have I accomplished?

  29. Working and not working

  30. Working and not working • Working and not working • Analyzes issues across multiple perspectives • Picture of how things are right now • Excellent for pinpoint problem solving before planning next steps

  31. The assessment shall identify supports that promote: • Rights • Self-determination • Physical well-being • Emotional well-being • Material well-being • Personal development • Interpersonal relationships • Social inclusion and community participation

  32. From the Imagine Discovery Guide This conversation guide is intended to provide the foundation for Discovery when someone is seeking support from a County Developmental Disability Service Board in Ohio’s Region V. The questions included are intended to contribute to the identification of current areas of the person’s life that are important TO and important FOR the person. This guide is the beginning of the discovery process. Further exploration and discussion are necessary when a specific area is identified as a potential area of needed or desired support.

  33. Person-Centered Planning

  34. The Intention of Person-Centered Planning • Improve the social status of people with disabilities • Enhance the perception held of people with disabilities • Expand the network of allies and associations in people’s lives

  35. Core Values • The Cuyahoga County Community and Medicaid Services Department • Respect • Positive Attitude • Commitment • Flexibility • Integrity • Professionalism

  36. Person-Centered Planning

  37. Integrating Assessment into the ISP • For each topic, discuss the person’s preferences and decide: • What does this person want to develop and/or change? • Are there any obstacles to address? • Does the person indicate an interest in pursuing other available services, providers, and/or staff?

  38. Integrating Assessment into the ISP • For each topic, discuss the person’s preferences and decide: • Are there opportunities to enhance the person’s independence, integration, and productivity? • Are there differences between what this person and the team want to develop and/or change? • Does the person choose a recurring or one-time support? • Is an action plan needed?

  39. One Page Profile Person’s Name: _______________________ This information comes from the person’s perspective. Complete this page based on communicating directly with the person. If additional information is needed, include information from people who have direct knowledge of the person’s perspective. What people admire most about me: What is most important to me: How to best support me: (Thanks to Clark County) Placeholder for picture

  40. _______________________’s Profile 1. Strengths & Talents(Things we appreciate and value) 6. Community Connections(What resources in the community will help reach success?) 2. Interests & Hobbies(What are favorite things or dislikes? Goals? Skills?) 7. Preferences & Priorities(What makes a good day/good life?) 3. Vocation/Living(Work interests? Volunteering? Daily living skills/pre-vocation?) 5. Supports Needed/Desired (Do’ and Don’ts) 4. Fears & Obstacles(What are barriers to success?)

  41. Some areas to consider • Life in Current Living Arrangements • Life in the Community and Social Activities • Life at Work • Life at Day Supports • School and Life-Long Learning • Health and Wellness

  42. Some areas to consider • Financial Life • Protection and Advocacy • Cultural Considerations • Behavioral Health • Mental Health • Transportation • Assistive Technology • Environmental Modifications

  43. Person-Centered Planning

  44. The most basic of the Medicaid Basic Assurances • Adequacy of current supports • Unmet needs • Relationships with medical professionals • Physical fitness

  45. The most basic of the Medicaid Basic Assurances • Nutrition • Dental care • Behavioral supports • Mental health • Advance directives

  46. Health and Welfare in John’s life

  47. Health and Welfare in LaToya’s life

  48. Health and Welfare in Bill’s life

  49. Person-Centered Planning