Monday, September 22, 2008

Latest news and information regarding DDRS system transformation

From DDRS:
Note:We have included several attachments and links that will be important to understand as we move into the new system. If you are unable to download or view the attachments, you may email or call (317) 234-5222 for assistance.

To: Consumers and stakeholders who support people with disabilities
From: Peter A. Bisbecos, DDRS Director
Date: September 22, 2008
Re: Latest news and information regarding DDRS system transformation

Vision 20/10
In 2006, the Division of Disability & Rehabilitative Services (DDRS) sponsored the first Vision 20/10 retreat. This retreat included numerous stakeholders from Indiana’s disability community. Out of that day came the DDRS mission, guiding principles and the vision of a fair, equitable, person-centered support system for people with disabilities in Indiana. We knew that making this vision into a reality would not happen overnight, would not be easy—and that it could not be done alone.

Click here to go online and view a short video message from DDRS Director Peter Bisbecos.

We are grateful to these farsighted stakeholders that include state staff, consumers, families and caregivers, advocates, providers and businesses for partnering on this journey. Together, we have already brought over 1,500 new people into waiver services; built a crisis management system; expanded proactive Outreach consulting services statewide; unified case management; started a training program that will teach direct support professionals to perform at an even higher level while offering them college credits; and together we closed our last state institution.
Amazing changes have happened to our system and for the people we serve, and the best is yet to come.

We are now at a critical point where all of our behind the scenes work, research, piloting, and planning is coming together. At the forefront of our efforts is the Objective Assessment System for Individual Supports, also known as OASIS. Already in pilot for people who live in west central Indiana, the Bureau of Developmental Disabilities Services (BDDS) District 4, we expect to begin transitioning the first groups of individuals to this new system in January 2009 (see timeline below.)
As we begin this process together, it is important to remember that for the first time OASIS will enable us to:
• Allocate resources to consumers based on an objective assessment of their needs
• Assist consumers in reaching their goals and dreams through a truly person centered process
• Retain and recruit service providers and direct service professionals (DSPs) who focus on quality outcomes and purpose-driven activities that provide consumers with meaningful days
• Make “work first” a fundamental part of our world
None of this can happen unless we also create a balanced work environment for families and providers. This must include:
• Simplifying administrative processes
• Monitoring quality through individual outcomes
• Maximizing efficiencies through technology
• Allowing the maximum amount of flexibility
The ultimate goal of OASIS is to have a system that helps people with disabilities achieve their hopes and dreams, while creating a rational business environment that can support the individuals we serve. Simply stated, OASIS is the vehicle that will take our vision forward.
In order to clarify how we intend to get there, this bulletin lays out several of the next steps in the process, and clarifies how they fit into the big picture.

For the past year, we have worked closely with key stakeholders to develop rates for services to ensure cost neutrality to our system. We are thankful to the consumers, families and providers who attended planning sessions and information sharing meetings. It is our intention to share information as we have it and we appreciate those who contacted DDRS staff or the OASIS ICAP help line if something was unclear.
In addition, we are thankful to the Self-Advocates of Indiana, Indiana Association of Behavioral Consultants (IN-ABC), the Arc of Indiana, INARF, Inc., and others. Individuals from each of these organizations have met with us on a regular basis throughout this entire process and have helped us to share information to their stakeholders. We look forward to continuing these partnerships moving forward.

Allocations and Transition Plans
We are in the process of formalizing a transition plan to ensure a seamless shift to the new system for all consumers. Because their health and welfare is our first priority, waiver consumers who see a notable change in annual allocation amount, whether an increase or decrease, will receive a transition plan. For some this may include extra supports to ensure a mix of services that support the individual’s needs. The timeline for each person’s transition may vary and will depend on the specific needs of the individual and the percentage of change in allocation.
Allocation budgets will be based on objectively defined needs. Exceptions to the allocation amount will be allowed only when justified.

Allocation Schedule for Current Waiver Consumers

Annual Assessment Dates Notification of Allocation
January 2009 November 2008
February 2009 December 2008
March 2009 January 2009
April 2009 and forward 90-120 days prior to annual assessment date

Tools, Reimbursement Rates and Service Definitions

Reimbursement Rates and Service Definitions
The Reimbursement Rates and Service Definitions (see attachment) becomes official on January 1, 2009 for waiver consumers in Indiana as they transition under the OASIS model. The document table includes definitions, allowable activities, consumer to staff ratios, and activities not allowed for each of these services listed on the rate table at the end of the document:
• Community Based Individual and Group Habilitation Services
• Facility Based Individual and Group Habilitation Services
• Pre-Vocational Habilitation Services
• Supported Employment Follow Along (SEFA)
• Transportation
For those who are familiar with the system pre-annual plan, the service definitions will look familiar. We are reverting to the old definitions between now and fall of 2009, when our state is required to resubmit our Developmental Disabilities waiver document to Medicaid. Use of these transition Service Definitions will allow time for us to thoroughly review and meet with our stakeholder to discuss possible changes that will better support the needs of consumers, families and providers.
As the new rates get underway, we will be closely tracking individual outcomes as well as how the changes are affecting the system overall. Between six (6) and nine (9) months into the process we will conduct a large scale assessment of the impact of the new rates on the system and usage of the invoicing tool to determine if further review or adjustments will be necessary.
Rates will be retro-effective April 1, 2008 for providers of consumers in Bureau of Developmental Disabilities Services (BDDS) District 4. Beginning January 1, 2009, individuals in the remaining BDDS districts will receive services under the new rates effective as they transition into their new plans under the OASIS model.

We sincerely appreciate the cooperation and extra effort put forth by providers in BDDS District 4 during the OASIS Pilot. Please note that we have included a chart at the end of this bulletin for BDDS District 4 providers only. This chart explains special considerations regarding the billing and reimbursement process that apply to you during the transition from the pilot into the OASIS system.

Documentation Standards

Providers of Home and Community Based Services (HCBS) on the Medicaid waiver are currently required to meet specific standards of documentation. The decision to revert to a previous version of the service definitions means we must review the documentation standards as well. We will be releasing an update to our documentation standards in a separate follow-up bulletin in the near future.

Interactive Budget Tool
The Interactive Budget Tool is a guide to assist consumers and families in planning. Completion of a budget using this tool produces an estimate of a mix of services an individual might receive based on their needs.
The tool is also an estimate for providers to make them aware of the service mix desired by the consumer, it does not indicate approval of desired services or budget amount. Ultimately, the case manager will be responsible for submitting a final budget to DDRS for review after a consumer's team has met. The Interactive Budget Tool is located online at:

Person Centered Planning Process
In conjunction with OASIS, an improved approach for Person Centered Planning (PCP) is underway. Using up-to-date and nationally acclaimed principles, the new PCP approach will seek to better identify consumer needs and desires. The new process frames supporting strategies in such a way that interdisciplinary teams can successfully direct resources to enable Indiana consumers to achieve stated outcomes. Key elements of the enhanced PCP approach include clearly defining the difference between what is important “to” consumers and what is important “for” consumers. This information is then available to team members as a document called the Person Centered Description (PCD).

The PCD is designed to enable teams to focus time and energies on strategies and tasks that support the Person Centered Plan. Case Managers will work with Providers to implement the new PCP system and to track progress toward achieving outcomes. Since annual planning and the new PCP/PCD process begins well in advance of the annual due date, the new PCP/PCD system will begin in January-2009 for those with annual plans due in July-2009.

Person Centered Service Planner

We have attached the latest version of the Person Centered Service Planner, formerly known as the Individualized Service Planner or Person Centered Service Agreement. Depending on your BDDS District, you may have used a few different versions of a service planner in the past year. The purpose of this document is for the team to identify the typical week of supports/services. This document will then be used to develop each individual’s Annual Plan of Care.
The mechanism used to invoice is currently in development. We are working diligently to ensure the final tool is as simple as possible to use by all service providers.
Invoicing for Residential Habilitation will require usage of the current Invoicing Tool. The current Invoicing Tool will not be used to bill for Community Habilitation and Facility Habilitation, using the new rates. A modified tool is being developed. Ultimately the long term goal is to have all invoices (waiver and state funded) calculated via one system.

Reimbursement Type by Service:
Service Reimbursement Type Invoicing Mechanism

Residential Habilitation Staff Hour Invoicing Tool

Community Habilitation Consumer Hour Not applicable

Facility Habilitation Consumer Hour Not applicable

Supported Employment Follow Along (SEFA)Consumer Hour Not applicable

Pre-Vocational Services Consumer Hour Not applicable

Transportation Per Round Trip Not applicable

Collaborative Communication and Training
Look for communication in the near future with details about future presentations and training sessions regarding OASIS and other DDRS initiatives. In October our plan is to meet with stakeholders to explain processes, documentation and other features of the new system. Later in the year, we will then travel the state to meet with consumers, families and other stakeholders to provide information and address any questions or concerns they may have.
We will continue to communicate information by posting it on our website, sending E-mails to our list serve including bulletins and newsletters, etc. As always, if you have any questions or concerns regarding the OASIS initiative you may continue to contact us through the following resources:
OASIS-ICAP Help Lines: (317) 234-5222 or 1-888-527-0008

Looking to the Future
Indiana has a rare spirit of cooperation that has allowed us to do many things that other states simply cannot. Building on this extraordinary strength, we invite all interested to work with us on defining the future for Hoosiers with developmental disabilities. In 2009, Indiana is federally required to renew the developmental disabilities (DD) Home and Community Based Medicaid Waiver document. To ensure that the new DD waiver puts us in the best possible position for the future, we have asked David Mank, Ph.D. of Indiana University’s Indiana Institute on Disability and Community to lead a community discussion that will guide the development of our new waiver.
Together, we will build on our collaborative relationships resulting in: true person centered planning and a fair and equitable system for the individuals we serve. My staff and I are
dedicated to the ongoing advancement of our system, including continuing the integral partnerships with stakeholders who support people with disabilities.
I thank you and hope you will continue to join us as we take the next steps in this monumental journey.

**BDDS District 4 Providers Only**
The following special considerations that apply to only BDDS District 4 providers as we transition from the pilot to the rollout phase of OASIS:

April 1, 2008 to
September 30, 2008
Due to the change in billing from staff hour to consumer hour for the community and facility habilitation (individual or group), providers in the pilot must use the Invoicing Tool to bill for reimbursement during this time period.
It is requested that all billing for this time period be submitted by October 31, 2008.
There will be a Cost Comparison Budget (CCB) conversion for individuals receiving services in BDDS District 4 that transitions to the new rates. This CCB conversion will only affect rates that increase; there will be no back dated change for rates that are less than the pilot amount.

October 1, 2008
Providers will begin billing based on consumer hour using consumer-to-staff ratios. This information will be provided in the provider’s Notice of Action (NOA).
Under the same conversion process noted above consumer hours will be entered onto the NOA from the information entered on the INTouch System in April 2008 by providers.
If an odd ratio was previously entered, the conversion will automatically default to the higher ratio. For example, if the ratio 7:1 was entered for Pre-Vocational Services, the ratio will default to 8:1.
For individuals on the Support Services Waiver (SSW) whose budgets exceed the $13,500 cap after the conversion, the plans of care will be reviewed on a case-by-case basis by the individual support teams.
The addition of transportation as a waiver service will require a plan update submitted by the case manager.

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