DDRS announcement regarding state line funding

Family Voices Indiana shares the following announcement from DDRS:

To: State Line and OBRA service providers

From: Jeanette Siener, Facility Based Services Director, Bureau of Developmental Disabilities Services

Re: OBRA and State Line Services update

Date: June 1, 2012

The Bureau of Developmental Disabilities Services (BDDS) has updated its Service Definitions Manual 

for State Line services and is available on the Division of Disabilities and Rehabilitative Services 

(DDRS) website under DDRS Manuals.  These changes and revised rates of reimbursement will be 

effective July 1, 2012. The revised rates of reimbursement reflect Medicaid waiver services rates.  

 The entire announcement, affecting primarily state line funding, in embedded below:

OBRA and State Line Services

Comment period for revisions to DSM disorders and criteria.....including ASD

 Family Voices Indiana shares the following opportunity to share your voice:

The draft disorders and disorder criteria proposed by the DSM-5 Work Groups for new and existing mental disorders can be found on these pages.  You will notice that the diagnostic chapters listed below are no longer organized according to DSM-IV. Instead, we have restructured the diagnostic chapters in DSM-5 to better reflect advances in our scientific understanding of psychiatric disorders, as well as to make diagnosis easier and more feasible for clinicians. You can read more about the proposed chapter structure by clicking here.

Proposed Draft Revisions to DSM Disorders and Criteria

Comment Deadline: June 15, 2012

The comment period has opened for the proposed changes to the diagnostic and statistical manual (DSM) of the American Psychiatric Association. These revisions include the often-discussed revisions to criteria for diagnosis of Autism Spectrum Disorders, among other things. Comments related to specific diagnoses or non-diagnostic specific issues may be made via the link above. The work group members will review all feedback and make decisions about further revisions based in part on the comments provided as well as on results from field trial testing, which is currently underway.

http://www.dsm5.org/proposedrevision/Pages/Default.aspx

With Katie Beckett Barely Put to Rest, Some State Legislators Try to Bury the “Katie Beckett Waiver” in Illinois

Family Voices Indiana shares this press release from National Family Voices. It is important for us to share our voice in support of families in Illinois, and to ensure our own  children continue to receive the supports they need here in Indiana in the future:

Springfield, Illinois, May 30  Less than one week after Katie Beckett was buried, the state legislature in Illinois will vote on legislation that could gut Illinois’ version of the Medicaid provision known as the “Katie Beckett Waiver.” In Illinois this is called the Medically Fragile and Technology Dependent Children’s Waiver Program (MFTW – sometimes called the MFTD), which allows children to receive specialized nursing care at home instead of in an ICU or institution.

In 1981 at the age of three and a half, Katie Beckett made history when President Ronald Reagan allowed Katie to go home from the hospital in Iowa where she had lived since the age of six months on a ventilator. Reagan explained the child was being kept in the hospital because of Medicaid rules which forbade paying for her home care, even though the cost to the government would be one-fifth the hospital charges of $10,000 to $12,000 per month. Reagan’s intervention set a new precedent, and shortly afterwards the government allowed exceptions in other states so that parents like the Becketts, who made too much money to qualify for Medicaid, could receive at-home coverage of extreme medical costs for their children. This provision became known as the “Katie Beckett Waiver.”

During the last three decades, more than half a million children in the United States have received waivers to get their care at home. On average, 500 – 700 children in Illinois per year benefit from the MFTW program.

Katie Beckett passed away on May 18 at the age of 34, and was buried in Cedar Rapids, Iowa on May 26. (To read about Katie Beckett’s life as an active advocate for children with special health care needs visit www.familyvoices.org .)

Senators in Illinois have recently passed a budget that funds state institutions instead of redirecting those resources to serve more people with disabilities by implementing home care in their communities. The House vote is pending this week. Local advocates for Children with Special Health Care Needs (CSHCN) are hoping the House will embrace the Governor’s Rebalancing Initiative which supports Respite Grants and the MFTW allowing CSHCN to receive Medicaid compensation for at-home care. The Arc of Illinois notes:

“For every one child in an ICU, five children can be funded to thrive in their homes. Home care
with the MFTW waiver is one-third the cost of hospitalization or institionalization, and the average enrollment
period is just 5-years. Illinois is going against the national movement to close state institutions and is the only
state to make such drastic cuts to the MFTW program.”

Family Voices, Inc. is a national non-profit based in New Mexico which provides support to family-to-family organizations in each of the 50 states that assist families of CSHCN. Executive Director, Dr. Sophie Arao-Nguyen said:

“National Family Voices supports efforts by The Arc of Illinois, Family Voices of Illinois, and other local groups to maintain the MFTW waiver in full force to best serve CSHCN in Illinois within their homes and communities, as well as to save money for the state. These waivers have been proven to work all over the country. We don’t want to see a precedent set in Illinois for gutting the waiver.”

The local Illinois group, “Save the MFTD Waiver,” www.savemftdwaiver.com has stated:

“The average cost for hospitalization in a pediatric hospital is $55,000 per month, while the average cost for children on the waiver cared for at home is $15,684 per month… Only 23 children would need to be permanently hospitalized to erase the $15 million Governor Quinn hopes to cut from the program’s budget.”

For more information please contact: Melanie Rubin, Director of Communications,
National Family Voices mrubin@familyvoices.org, 505-872-4777, www.familyvoices.org

New state rule may save lives for trauma patients and ISDH listening tour

INDIANAPOLIS—Hoosiers who suffer traumatic injuries are now more likely to be treated at verified trauma centers immediately following an injury, thanks to the adoption of the Triage and Transport Rule by the state’s Emergency Medical Services (EMS) Commission. The rule aims to better provide critical quality care during the first 60 minutes following a traumatic injury, known as the “golden hour” of care in emergency medicine.          

"In our efforts to create a statewide trauma system, this rule is foundational,” said State Health Commissioner Gregory Larkin, MD.  “It should mean more severely injured patients will be taken directly to trauma centers, and it should also mean more hospitals will become trauma centers." 

The rule advises that once EMS personnel have assessed the condition of each patient at the scene of an incident, they should then determine if the patient falls into the most severe categories of trauma injury as defined by the Centers for Disease Control and Prevention.  If so, the patient must be taken to the nearest trauma center.  The exceptions may include if transporting the patient would take more than 45 minutes, a patient’s right to decide or if the patient’s life will be endangered if care is delayed by going to the nearest trauma care center.  In these scenarios, the patient should be taken to the nearest appropriate hospital, as determined by the EMS provider protocols.

Traumatic injury is the number one killer of Hoosiers under the age of 45.

“Our number one priority is ensuring patients with traumatic injuries receive the lifesaving care they need, when they need it,” said Arthur L. Logsdon, director, Trauma and Injury Prevention at the Indiana State Department of Health. “Trauma centers utilize specific medical equipment and have skilled medical professionals available to handle the most severe, blunt force and puncture wounds. Trauma centers are proven to save the lives of those who have suffered the most devastating injuries. I am pleased the EMS Commission has voted positively on this rule.”

In fact, nationally, there is a 25 to 30 percent greater chance of survival when severely injured patients are taken to a trauma center versus an emergency room.

Trauma centers differ from hospital emergency rooms in some significant ways. Emergency departments are not trauma centers, as the typical emergency department treats broken legs, concussions, back sprains, lacerations, injuries resulting from motor vehicle rear-end crashes and trips on the sidewalk. Trauma center “typical patients” include those with multiple fractures, brain injuries, paralysis, punctured lungs, handgun and stab wounds, car rollovers and ejections or falls of more than 20 feet. They are verified by the American College of Surgeons.

Indiana has emergency medical services providers, trauma centers and a trauma registry to track these most severe of injuries, but is one of only nine states that do not have an integrated statewide trauma system.

Indiana has eight verified trauma centers:

• Deaconess Hospital, Evansville
• St. Mary’s Medical Center, Evansville
• Lutheran Hospital of Indiana, Fort Wayne
• Parkview Hospital, Fort Wayne
• IU Health Methodist Hospital, Indianapolis
• Wishard Memorial Hospital, Indianapolis
• IU Health Riley Hospital for Children, Indianapolis
• Memorial Hospital of South Bend, South Bend

In 2008, Senator Tom Wyss (R-Fort Wayne) authored Senate Enrolled Act 249 which tasked the EMS Commission with creating a rule to establish protocols for the transporting of trauma patients.

“I applaud the work of the EMS Commission and the state agencies involved in passing this rule,” said Senator Wyss.  “I wanted to make sure that Hoosiers were being taken to the proper destination after suffering a traumatic injury. This rule is one more step in the right direction toward patient safety and quality care.”

The Indiana State Department of Health’s Division of Trauma and Injury Prevention will conduct a Trauma Listening Tour this summer.  The goal is for Hoosiers to learn more about trauma, learn how state and local agencies currently respond to trauma, learn how an integrated trauma system could help the state and, most importantly, gather personal stories of how trauma has affected those in our state. To learn more about the Trauma Listening Tour, visitwww.StateHealth.in.gov.

DD/ASD waiver webinar

Family Voices Indiana shares the following notes from the DD/Autism webinar with Shane Spotts. The webinar was recorded and will be available for viewing soon. We will share that info when it becomes available. DDRS also plans to have a Q&A opportunity for families to ask questions and get answers

Proposal to combine DD and Autism waiver into a Community Integration and Habilitation Waiver:

Family Support Waiver will be new point of entry (no longer need to be on waiting list in future)for  the DD waiver system in Indiana

Families have told DDRS that if they have a little bit of support, that would be helpful, so new waiver system hopes to provide that

Many people are on both waiver waiting lists (DD and Autism) . 15-20% of individuals on DD and SS waiver have an autism diagnosis

Combining these waivers should not have a negative effect on the autism community

Will have positive impact on administrative costs for further cost savings allowing money to go to individuals instead of state

You will not lose your spot on the waiting list, they will use those dates to move people onto the new Family Support waiver

There are still emergency services available for priority criteria: loss of caregiver, caregiver over 80, evidence of abuse/neglect in institutional placement, extraordinary health and safety risk

Plan to submit plan to CMS for this proposal in next 2 weeks

Question/Answer period:

Effective date of September 1 for these changes

You can find out where you are on the waiting list via BDDS or the DDRS online portal

People already on the waiting list don’t need to do anything differently. DDRS will be sending out communications to let families know what to do in future

If you are already on the DD or Autism waiver already, you will not notice change in services.  You will see little to no change

If you already have SS waiver and move to Family Support Waiver, you will only move to new waiver by meeting needs based/emergency criteria

Needs based criteria for new waiver is being developed. Policy will be released with definitions.  Emergency criteria will provide for flexibility as needed.

Family Support Waiver will grow and be more comprehensive. If you meet needs based criteria for new Community Integration and Habilitation Waiver, you will move to it when appropriate

DDRS will talk with families with children with high functioning autism about eligibility

ABA services are in the discussion phase. IBI: intensive behavioral intervention- is on waiver and will stay there

Family Supports Waiver is capped and will include participant assistance and care, a type of residential support

DDRS is supportive of living independently with Family Support Waiver if you can do it within that budget.  Larger societal issue is that many individuals are living at home longer and with roommates, so there is expectation that DD population will do the same. Waiting list needs to be eliminated first.

The day this is approved, SS waiver will convert to Family Support Waiver with budget and new service

Case management will allow for multiple options if proposal approved by CMS

DDRS will work with DCS status children

Individuals on waiting list will be moved into services as soon as possible over the next 3-5 years

Hope is to target 5200 people a year to receive services

Individuals with mental health and DD issues may meet priority/needs based criteria: depends on individual

Currently 19K people are waiting for services (some duplicated counts)

Must meet LOC and eligibility for waivers, as is true now. Will address new definition of autism in future

Those currently on A&D waiver with DD diagnosis and meet eligibility can move to those waivers

Hope is longest anyone will wait will be 4 years to get a waiver and then waiver waiting list eliminated. Plan is to get everyone some support and then reevaluate.

Everyone will be on same waiting list and will move you to FSW based on application date. FAQ will be posted

People can continue to be state supported with supported employment and VR for employment

Impact of possible new governor is unknown

Adult foster care will continue to be an option

High cost/high need individuals may get support beyond traditional RHS. Proposal being developed

All questions will be answered and posted on DDRS, ASI and IRCA, etc in future

Family Voices Indiana thanks DDRS, ASI and IRCA for having this discussion with families

Caregiver support/respite funds will be available for those on DD waiting lists 6/25

 Family Voices Indiana shares the following information from DDRS:

To: DDRS Consumers and Stakeholders

From: Division of Disability and Rehabilitative Services

Re: Caregiver Support Services Funds

Date: May 25, 2012

The Division of Disability and Rehabilitative Services announces the Caregiver Support Services

funds will be available for the fiscal year - July 1, 2012 through June 30, 2013. The Caregiver

Support Services is 100% state funded.

Services will be available on a first-come, first-served basis and an application must be

completed for each fiscal year’s Caregiver Support Services funds. Previous applications during

fiscal year 2012 for Caregiver Support Services do not carry over to fiscal year 2013.

The application for Caregiver Supports Services must be made in person at the Bureau of

Developmental Disabilities Services district offices by the primary caregiver, OR, if eligibility has

not yet been determined for the individual, the primary caregiver and the individual must

complete the application in person at the district offices. (If the individual has already been

determined eligible for BDDS services, the individual is not required to be present.)

The primary caregiver and the individual(s) may apply for Caregiver Support Services at the

BDDS district offices on and after Monday, June 25, 2012. (Application is available on the DDRS

Forms webpage to print, complete and bring to District Office to submit.)

As long as the Caregiver Support Services funds are available, the Caregiver Support Services

can be approved and available when 1) individual meets the state definition of Intellectual and

Developmental Disabilities and 2) the primary caregiver selects a provider. The individual

cannot receive Caregiver Support Services and receive any other state funded services, such as

VR services, First Steps, CHOICE, Division of Aging waiver, etc.

Medicaid waiver webinar from DDRS

Family Voices Indiana shares the following information about a webinar regarding the DD and Autism waivers. Please see info below.......

The Division of Disability and Rehabilitative Service (DDRS) with the Autism Society of Indiana and Indiana Resource Center for Autism is hosting a webinar on May 30, 2012, at 9 a.m. to discuss the combining of the Autism and Developmental Disability Medicaid Waivers.

This event requires registration. However, if you are unable to participate in this event, the presentation will be recorded and posted to the DDRS website within one week.

To register for the online event use the following URL.

https://autismindiana.webex.com/autismindiana/onstage/g.php?d=668201539&t=a&EA=dana%40inautism.org&ET=b305102fae45f4df4ba24d5282cd6dbf&ETR=aa753e4de908d778044421270198303a&RT=MiMxMg==&p

2. Click "Register".

3. On the registration form, enter your information and then click "Submit".

Once the host approves your registration, you will receive a confirmation email message with instructions on how to join the event.  If you do not have access to the internet, you can call in and listen to the presentation using the following number:
1-650-479-3207  Access code: 668 201 539

There will be an opportunity for you to post questions during and following the presentation.