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June 1, 2001 (First Edition)

I. Introduction

II. Major Policy Directions

III. Major Initiative

IV. Going Forward

V. Conclusion

  1. Introduction:

This report, the "First Edition" of Indiana’s Comprehensive Plan for Community Integration and Support of Persons with Disabilities, presents the initial efforts of Indiana’s planning process for more fully integrating persons with disabilities into community-based living. It presents specific action steps including goals, timelines and the parties responsible for assuring progress in each of the action step areas. These action steps have been defined as the immediate steps which must be taken by the Family and Social Services Administration (FSSA) and by other departments and agencies which must also be involved in order for the plan to succeed. Limitations on the funding available to carry out these activities may affect timelines and due dates. However, FSSA is firmly committed to achieve these action steps.

It is clear that the action steps identified here represent only the beginning of the process. True systems change requires a sustained effort over the long term. While legislative budget cycles limit the ability to set specific goals beyond the 2002-2003 biennial budget cycle, the longer term vision must also continue to be articulated. FSSA is committed to maintaining this plan as a living document. A "Second Edition" and successive editions will contain further development and refinement of this vision. Two major efforts, described in Section IV "Going Forward", will assure that the planning effort is kept on track and moving forward and that initial steps taken now will begin to define the shape of systems change over the long term.

This report is divided into five sections: Introduction, Major Policy Directions, Key Initiatives, Going Forward, and Conclusion.

  1. Major Policy Directions

Through testimony recorded at public meetings, information solicited through interviews and focus groups and analysis of Indiana’s current efforts, six major policy directions that will advance the development of community-based services have been identified. These policy directions are outlined below, and broad options for change that cut across all disability groups are given. These Policy Directions have been formally presented to the public at a series of twelve public meetings across the state, conducted from April 16 – 26, 2001. At the meetings the directions received strong public support.

Policy Direction #1: Emphasize Consumer Choice: Enable individuals to receive the types of services they desire in the location they prefer.

Consumers should have the ability to live and work in the location they prefer, with appropriate supports and services to enable them to do so. Funding should follow the consumer, not the provider, and should be adequate to meet the needs of all who qualify. Use of individual budgets should be maximized to ensure that funding is channeled in ways most responsive to consumer needs.

Policy Direction #2: Provide information, assistance and access to consumers to increase their opportunity for informed choice.

Information on services and funding needs to be easily available to all people with disabilities. Access to these services needs to be strengthened and provided in culturally appropriate ways for all of Indiana’s citizens.

Policy Direction #3: Support the Informal Network of Families, Friends, Neighbors and Communities.

Family caregivers provide far more supportive services for people with disabilities than is provided through paid services. With family size shrinking, more two person wage earners families and the population growing older, the ability of family caregivers to sustain this level of effort is strained. Providing support to caregivers becomes ever more important. In addition, volunteer efforts should be recognized for the value they provide. Self-advocacy, support groups, and other creative ideas for enabling individuals within the community of persons with disabilities to provide mutual support and assistance should be fostered.

Policy Direction #4: Strengthen Quality Assurance, Monitoring Systems, Complaint System, and Advocacy Efforts.

Hoosiers deserve high-quality services wherever they receive them. Consumers need better information on the quality of care delivered, and deserve an effective system that responds to consumer complaints in a timely way.

Policy Direction #5: Increase the System Capacity for Provision of High Quality Care.

In many areas, the capacity of the service delivery system needs to be strengthened. The state agency infrastructure needs to be adequate to recruit providers and assist in development of new alternatives. Data and system issues such as timeliness of provider payments need to be addressed.

Policy Direction # 6: Create a coordinated workforce development system that recruits and supports a stable resource of direct support staff.

In order to meet the needs of current and future numbers of persons with disabilities needing supports and services so they can live and work in communities, the pool of workers with sufficient skills and training needs to significantly increase. It is important that the State take steps to ensure a stable and motivated workforce.

  1. Major Initiatives

At the public meetings held April 16 – 26, 2001, strong testimony was given to the need for the Plan to contain specific deliverables – including timeframes and responsible parties, to assure that the plan is accountable. This section contains such accountable action items. It is focused on the next two year period. Action steps are provided with specific goals, timelines, and the responsible party for carrying out the action. Where an action step relates to a particular target group, the group will be specified; however, the plan includes all groups under each policy direction to show the overall systems impact that the changes, taken together, can have.

Policy Direction #1: Emphasize Consumer Choice: Enable individuals to receive the types of services they desire in the location they prefer with Individual Budgets.

Consumers should have the ability to live and work in the location they prefer, with appropriate supports and services to enable them to do so. Funding should follow the consumer, not the provider, and should be adequate to meet the needs of all who qualify. Use of individual budgets should be maximized to ensure that funding is channeled in ways most responsive to consumer needs.

Recommendations:

  • Reduce Indiana’s reliance on institutional care by working with providers to develop ways of de-emphasizing nursing home care and reducing the population of individuals served in state operated facilities.
  • Advance administrative systems and policies that improve the State’s ability to use any savings from decreases in expenditures for institutional care (whether for state-operated facilities or for nursing homes) for the expansion of community-based care.
  • Make available a full range of effective traditional and non-traditional community options and supports through waiver mechanisms and a fiscal intermediary.
  • Cultivate new and creative options for community-based services and supports.

Action Steps, Goals and Timelines Related to Policy Direction #1

  1. Small pilot programs for consumer-directed personal assistance services have been established under the Community and Home Options to Institutional Care for the Elderly and Disabled (CHOICE) program. The experience gained from these pilots will be valuable in expanding this option to the Medicaid waiver programs. The State should explore amending the waivers to incorporate consumer-directed personal assistance as they come up for renewal. Changes to the Aged and Disabled waiver should be examined and decided upon by March 2002. Ultimately, responsibility for waivers is vested with the Office of Medicaid Policy and Planning (OMPP). However, for accountability purposes, decisions on specific responsibilities are made on each action step. Responsibility: Division of Disability Aging and Rehabilitation Services (DDARS)/OMPP. Timelines: Upon Medicaid waiver renewal dates, Fiscal Years 2002-2003.
     
  2. Where feasible under Health Care Financing Administration (HCFA) regulations, experience and expertise in providing home care options through more flexible mechanisms which have proved successful in the CHOICE program should be used as a model for the waiver program. HCFA guidelines are currently being reviewed for the feasibility of increasing flexibility using this model. This includes possible delegation of authority to the local level and streamlining, (such as approval of plans of care and approval of providers through a memorandum of agreement process); and adding services not currently covered, such as specialized medical equipment, transportation, payment for evaluation service prior to purchase of adaptive aids and devices or home modifications. Changes to the Aged and Disabled waiver should be examined and decided upon by March 2002 and recommended amendments will be sent to HCFA. Other waiver amendments should be submitted for approval by HCFA as part of the waiver renewal process. Responsibility: DDARS/OMPP. Timeline: For Aged and Disabled waiver, March 2002 and for other waivers’ on Medicaid waivers renewal dates.
     
  3. Indiana has submitted to HCFA requests for Medicaid waivers for Assisted Living and for Adult Foster Care. After HCFA approval, more specific planning will take place regarding administrative rules, standards and sanctions and required training FSSA should develop a plan for all remaining details needed, including possible additional legislative approvals, and be prepared to request what is needed during the next legislative session. Responsibility: DDARS/OMPP. Timeline: Will be completed by 12/31/01.
     
  4. Adult Day Care Services will be enhanced in Fiscal Year 2002. Additional levels of service will be available, for three levels of functional disability rather than the current single level. Extended hours should also be available, in order to allow families to coordinate arrival and departure prior to and after work hours. HCFA approval of the waiver necessary to accomplish this has been received. Responsibility: DDARS. Timeline: Will be implemented by 12/31/01.
     
  5. The Medicaid budget request for funding of additional slots for the Aged and Disabled waiver was approved. This will allow for the addition of 822 slots for Fiscal Year 2002 and 813 additional slots for Fiscal Year 2003. Also, $6 million in additional funds was appropriated each year of the biennium for Indiana’s in-home services programs. This includes at least $3 million for the CHOICE Program and $3 million which can be used at FSSA’s discretion for the CHOICE program or as state matching funds for the Aged and Disabled waiver. This will enable additional individuals to receive assistance in their own homes rather than necessitating placement in a nursing home. Responsibility: DDARS/OMPP. Timeline: Will be implemented for Fiscal Years 2002 and 2003.
     
  6. Subject to HCFA approval, changes are being incorporated into the Developmental Disabilities (formerly the ICF/MR) waiver to allow for greater flexibility, including: broader categories for reporting and rate structuring (moving toward community or residential habilitation as a general category rather than elaboration of specified services); community participation reimbursement, including activities to enhance, teach, and/or support community living or vocational skills (volunteering, spectator sports, leisure activities, etc.); payment for transportation for community activities; determination of Level of Care at the local level; flexibility in training for family members; and allowance for room and board costs of a full-time caregiver who lives in the home of the waiver recipient. Responsibility: DDARS/OMPP. Timeline: Implemented by October 1, 2001.
     
  7. The Medicaid budget appropriation was approved for 440 additional Developmental Disabilities waiver slots in Fiscal Year 2002 and 372 additional waiver slots for Fiscal Year 2003. With the revisions to the Developmental Disabilities waiver, it will also be possible to serve approximately 1500 individuals through the Medicaid program that are currently being served with 100% state dollars. This will free up state resources to serve additional people under the Developmental Disabilities and Autism waivers. Responsibility: DDARS Timeline: October 1, 2001 for waiver revisions, Fiscal Years 2002 and 2003 for additional waiver slots as appropriated.
     
  8. FSSA is working with the Indiana Department of Education (DOE) and the Indiana State Department of Health (ISDH) to look at the current system of providing services for children and to make improvements to the system. Issues to be addressed include: finding the most appropriate setting for children; utilizing the most appropriate funding source; planning for the transition of children from the Division of Family Resources/Department of Child Services (DFR/DCS) and the DOE systems into services provided by DDARS and the Division of Mental Health and Addictions (DMHA), as well as into the community; making certain that children and parents retain their rights; and providing the most appropriate services for each child. Responsibility: FSSA, with assistance from DOE, ISDH. Timeline: The plan will be completed by 12/31/01, with implementation beginning in 2002.
     
  9. Consideration is being given to expanding the targeted case management services for children with a serious emotional disturbance to include private providers, in addition to the community mental health centers that are included now. Responsibility: DMHA, working with DFR and OMPP. Timeline: Determine feasibility by January 1, 2002.
     
  10. House Enrolled Act (HEA) 1950 provides for implementation of the Medicaid Buy-In Program for People with Disabilities. The goal is to bring adults with disabilities into gainful employment at a rate that is as close as possible to that of the general adult population and to support the goals of equality, opportunity, full participation, independent living, and economic self-sufficiency for individuals with disabilities. The bill establishes a Medicaid Work Incentives Council (MWIC), with appointments to the council to be made by the Governor. Responsibility: OMPP. Timeline: Appoint members by July 1, 2001. Plan developed for implementation of HEA 1950 by January 1, 2002.
     
  11. Establishing the Southeast Regional Service Center from resources at Muscatatuck State Developmental Center (MSDC) and Madison State Hospital (MSH). DDARS is responsible for finding appropriate placements for 350 individuals with developmental disabilities from MSDC (and MSH) by 6/30/2003. In order to do this, provider/community capacity must be enhanced. Plans are being developed to move people now in group homes onto the Developmental Disabilities waiver and recertify existing group homes for more intensive care. This would provide an opportunity for individuals living in large, congregate settings to move into neighborhoods and to participate in community activities. It would also provide individuals currently living in communities, who need more direction and supervision, an opportunity to receive the appropriate amount of support without being placed in a large, congregate setting. (See also related activities under Priority #5, expanding community capacity.) Responsibility: DDARS. Timeline: Place all state facility residents targeted for placement into appropriate settings by June 30, 2003.
     
  12. Appropriate services need to be developed for individuals with a dual diagnosis of developmental disabilities and mental illness, and for individuals with the occurring disorders of mental illness and addiction. FSSA is currently exploring the feasibility of a proposed effort (the ALPHA Project) to implement a pilot integrated service delivery system in one county for adults with mental illness and developmental disabilities. Responsibility: Secretary’s office of FSSA. Timeline: Feasibility study to be completed by January 1, 2002.
     
  13. Establish a Technical Assistance Center to train potential Assertive Community Treatment (ACT) providers. The Division of Mental Health and Addictions (DMHA) will contract by October 1, 2001; and will establish and operationalize at least one ACT team by July, 2002.
     
  14. Determine populations that are going to be served by the Southeast Regional Service Center by October 2001; and develop plan for Central Indiana Regional Service Center. Responsibility: DMHA/DDARS. Timeline: January 2002.
     
  15. Continue to downsize the state psychiatric hospitals’ statewide census by 100. Responsibility: DMHA. Timeline: Jan. 2003.

Policy Direction #2: Provide information, assistance and access to consumers to increase their opportunity for informed choice.

Information on services and funding needs to be easily available to all people with disabilities. Access to these services needs to be strengthened and provided in culturally appropriate ways for all of Indiana’s citizens.

Recommendations:

  • Develop the capacity to provide information and referral to all consumers, through individuals with sufficient training and experience to appropriately identify and assess the needs of the diverse population who require services. Options need to be explained thoroughly to consumers and their families, and all alternative sources of funding need to be explored.
  • Strengthen the system of case management. The various roles of case managers need to be clearly articulated.
  • Make assistance uniformly available in all geographic areas.
  • Centralize information about service quality and availability within FSSA and make information widely available to consumers and providers.

Action Steps, Goals and Timelines Related to Policy Direction #2

  1. A need exists for additional training of staff of Area Agencies and Aging (AAAs) as well as other case managers. In particular, staff providing information and assistance or case management require training, in order to increase their ability to provide opportunity for consumers to make informed choices. DDARS is currently in the process of contracting for this additional training. Responsibility: DDARS. Timeline: Contract for additional training will be in place by July 1, 2001.
     
  2. All facilities meeting the state definition of "Housing with Services Establishments" (assisted living) are required to disclose specified information (rates, contract requirements, etc.) to the DDARS Bureau of Aging & In-Home Services (BAIHS). The records in this database are made available to consumers to assist them in choosing a residence that best meets their needs. A web site has recently been implemented to make access to this information easier for consumers. The information is also available through the AAAs, or via a phone call to BAIHS. Responsibility: DDARS. Timeline: Currently in operation; refinements in the web site to insure ease of access are ongoing.
     
  3. SB 215 was passed by the General Assembly and signed by the Governor. It provides the mechanisms for consumers to self-direct their attendant care under CHOICE and Medicaid Waiver funding. This law contains provisions for a registry of care workers. This information will be made available to consumers to have more informed choices in hiring an attendant care worker. Responsibility: DDARS. Timeline: Will be implemented in Fiscal Year 2002.
     
  4. Indiana has been allocated $2.3 million to implement the National Family Caregiver Support Program. Two components of this program are information and assistance to access services. BAIHS is currently working with the AAAs to develop specific activities under this program, including providing greater access to information on caregiving issues to enhance consumers’ choices. Responsibility: DDARS. Timeline: Contracts will be effective July 1, 2001.
     
  5. In order to provide closer, more convenient access points into the system for consumers within their neighborhood, decentralization of local Offices of DFR is occurring for 12 to 14 larger counties to divide them into office locations of 50 or fewer staff. Responsibility: DFC/DCS. Timeline: Process will be implemented as leases expire or come up for renewal.
     
  6. DDARS has contracted with a nationally recognized consultant to assist the State in developing a more responsive waiting list system for all Medicaid waivers. A system will be developed to determine individuals’ needs, to better understand the immediacy of needs of those on the waiting list and provide the opportunity for more appropriate and timely assistance. This system will be managed at the state level, once developed. Responsibility: DDARS. Timeline: New system will be in place by June 30, 2002.
     
  7. The Supporting the Hoosier Assurance Plan through Education (SHAPE) program is a new consumer education program developed to provide information to help Indiana residents make an informed choice of provider and services under the Hoosier Assurance Plan (HAP) and to learn about their rights and responsibilities under HAP. The SHAPE program is in place and implementation has begun. Responsibility: DMHA. Timeline: By June 2002, all consumers in the system will have had an opportunity for face to face or phone training and will have received a packet of information.

Policy Direction #3: Support the Informal Network of Families, Friends, Neighbors and Communities

Family caregivers provide far more supportive services for people with disabilities than is provided through paid services. With family size shrinking, more two person wage earners in families and the population growing older, the ability of family caregivers to sustain this level of effort is strained. Providing support to caregivers becomes ever more important. In addition, volunteer efforts should be recognized for the value they provide. Self-advocacy, support groups, and other creative ideas for enabling individuals within the community of persons with disabilities to provide mutual support and assistance should be fostered.

Recommendations:

  • Develop methods for families and advocates to actively participate in quality assurance systems.
  • Strengthen programs providing education, training and respite services for family caregivers.

Action Steps, Goals and Timelines Related to Policy Direction # 3

  1. Programs being developed under the National Family Caregiver Support Program will provide information to caregivers about the availability of support services and assistance to caregivers in gaining access to services. Specific services available will include individual counseling; organization of support groups and caregiver training to assist in making decisions and solving problems; respite care; and supplemental services. An infrastructure of program resources and assistance will be developed through the AAAs to support family caregivers, including a special focus on grandparents raising grandchildren. Responsibility: DDARS. Timeline: Will be implemented in Fiscal Year 2002.
     
  2. The Children’s CHOICE program will be ready for implementation this year. This new program will leverage $1 million in Temporary Assistance for Needy Families (TANF) funds, to help support eligible families of children receiving services through CHOICE. A total of $2,000 per family per year will be available for family caregiver services. Responsibility: DDARS. Timeline: Implementation will begin July 1, 2001.
     
  3. Increase availability and usage of the federal Family Unification Program (FUP), which can be accessed to assist with housing deficiencies for families at risk of being separated due to inadequate housing, including but not limited to, children in the welfare system. Responsibility: DFR/DCS. Timeline: A plan will be in place by January 1, 2002.
     
  4. Family Support Respite Services, targeted to families of persons on the waiting list, are included in Support Services waiver being developed as part of the revisions to the DD waiver. (See Action Step # 6 under Policy Direction #5).

Policy Direction #4: Strengthen Quality Assurance, Monitoring Systems, Complaint System, and Advocacy Efforts

Hoosiers deserve high-quality services wherever they receive them. Consumers need better information on the quality of care delivered, and deserve an effective system that responds to consumer complaints in a timely way.

Recommendations:

  • Develop effective ombudsman and consumer advocacy programs for all in need.
  • Make available the Adult Guardianship program in all counties, so that individuals unable to speak for themselves and lacking families will have someone to speak for them.
  • Ensure that conflicts of interest do not exist for case managers (for example, where agencies may provide both case management and other supportive services).
  • Assure oversight of and accountability for all quality assurance activities conducted for institutional and community-based care and services.

Action Steps, Goals and Timelines for Policy Direction #4

  1. The Ombudsman program will be expanded to cover certain community-based alternatives to institutional care which are being expanded through both new and existing waiver programs. Funding has been authorized in the biennial budget in the amount of $339,000 per year for Ombudsman Services for Assisted Living and Adult Foster Care. The program will be developed in a manner that will allow these state funds to be used as matching funds, to maximize the opportunity for federal Financial Participation. Responsibility: DDARS. Timeline: Planning for this expansion of the Ombudsman program will be coordinated with other planning activities needed for implementation of the Assisted Living and Adult Foster Care waivers. Specific details will be developed by December 31, 2001.
     
  2. An additional $657,000 has been appropriated for each year of the biennium for the Adult Guardianship Program. This will enable services to be available on a statewide basis, expanding the program which is presently available in 23 counties. Responsibility: DDARS. Timeline: Will be implemented by January 1, 2002.
     
  3. The Adult Protective Services Program (APS) receive an additional $1.4 million for each year of the biennium, to extend hours of service and to serve additional individuals. This funding will increase capacity for approximately 550 persons to be served. Responsibility: DDARS. Timeline: Will be implemented as of July 1, 2001.
     
  4. Indiana is one of 12 states participating in a pilot Performance Outcomes Measures Project sponsored by the U. S. Administration on Aging. This grant project is targeting outcome measures including: caregivers, case management, information and assistance, nutrition and several other areas. Each measurement contains extensive criteria. For example, the caregiver survey includes questions about the provision of services designed to assist the caregiver, e.g., respite care, from the point of view of the caregiver. Responsibility: DDARS. Timeline: Currently in operation as a grant project. Expected implementation is dependent upon final demonstration results.
     
  5. Preliminary Provider Standards for all individuals with developmental disabilities will be included in contracts that go into effect on July 1, 2001. This includes services provided through the Developmental Disabilities, Autism and Aged and Disabled waivers and all services provided through the Bureau of Developmental Disabilities Services (BDDS) (Respite, Day Services, etc.). There will be a six month trial period, before the final standards are submitted for rulemaking. Responsibility: DDARS Timeline: Final Provider Standards published in the Indiana Register on March 1, 2002.
     
  6. The Quality Monitor positions who oversee the quality of services to persons with developmental disabilities will be transferring to the DDARS Bureau of Quality Improvement Services (BQIS) effective June 15, 2001. A tool is being developed for use that coincides with the provider standards mentioned above. The roll out of the use of this tool will begin July 1, 2001, with the Quality Monitors being fully trained on using the tool for monitoring and quality assurance by January 1, 2002. Responsibility: DDARS. Timeline: Fully implemented by January 1, 2002.
     
  7. DFR/DCS will continue to improve the child welfare Quality Assurance Review process, under which peer reviewers evaluate each of the 92 local Child Protective Services (CPS) offices every two years. This process helps insure accountability and responsiveness to the public by identifying office strengths and weaknesses, and developing a local action plan to address the weaknesses and build upon the strengths. Responsibility: DFR/DCS, working through local Offices of Family Resources and Department of Child Services. Timeline: All plans will be in place by October 1, 2001.
     
  8. Indiana is one of 16 states participating in a pilot program for mental health system performance measures. Under a contract with SAMHSA/Center for Mental Health Services, Indiana is helping to define a pilot over 30 indicators including use of best practices, functional outcomes, and consumer self reports. Responsibility: DMHA. Timeline: September 2002.

Policy Direction #5: Increase the System Capacity for Provision of High Quality Care

In many areas, the capacity of the service delivery system needs to be strengthened. The state agency infrastructure needs to be adequate to recruit providers and assist in development of new alternatives. Data and system issues such as timeliness of provider payments need to be addressed.

Recommendations:

  • Recognize the role of affordable housing as the single biggest need for individuals who are at risk of institutionalization. Strengthen linkages between "service" agencies and organizations responsible for housing.
  • Make transportation and employment opportunities more widely available. Agencies responsible for these areas must work closely with providers of supportive services.
  • Develop the infrastructure needed for new Home and Community Based Services (HCBS) waiver programs; recruitment of adult foster care providers; education for caregivers on adult day care as an option; and enhancement of the policies, procedures and staff needed for monitoring quality in assisted living facilities.
  • Address transportation, employment and housing needs of all persons with disabilities through multi agency focus by FSSA and the Governor’s Office.

Action Steps, Goals and Timelines Related to Policy Direction #5

  1. To prepare for implementation of the Medicaid waiver Assisted Living Program, providers will need to be recruited. Plans for outreach and training will be developed by 12/31/01, in preparation for recruiting sufficient numbers of qualified providers to implement the Medicaid waiver program once appropriate authority for implementation has been obtained. Responsibility: DDARS. Timeline: Plans will be completed by 12/31/01, in preparation for implementation in 2002.
     
  2. Implementation of SB 215 will enhance the ability of Indiana consumers to self-direct their care. The ability of a consumer to hire, train, and fire a care worker is specifically aimed at increasing the capacity for the provision of high quality care and consumer empowerment. Responsibility: DDARS. Timeline: Will be implemented by June 30, 2002.
     
  3. The state budget recently passed by the Indiana General Assembly contains provisions for increasing provider rates. These increases are targeted specifically for direct care staff to enhance the quality of care. Responsibility: DDARS. Timeline: Will be implemented beginning October 1, 2001.
     
  4. Increase Independent Living resources to aid foster children who are transitioned from foster care to adulthood in an effort to better prepare them should be increased; increase partnerships with public and private groups to maximize utilization of Independent Living resources. Responsibility: DFR/DCS. Timeline: A plan will be in place by January 1, 2002 and substantially implemented by July 1, 2002.
     
  5. Streamline the Family Preservation contracting process Title IV-B in an effort to improve timeliness of contracts and payments for providers and to standardize the fiscal year on which numerous programs operate. Responsibility: DFR/DCS. Timeline: A plan will be in place by January 1, 2002.
     
  6. DDARS is developing a Targeted Case Management waiver and a Support Services waiver as part of the process of revising the current ICF/MR waiver. The Support Services waiver will include family support and respite services for families of persons on the waiting list and supported employment and day habilitation for individuals already served by Adult Day Services. Funding will be shifted from Adult Day Services state funding to the Medicaid waiver program, enabling Indiana to access additional Federal Financial Participation and use state resources more effectively. Responsibility: DDARS. Timeline: Targeted Case Management waiver will be implemented by October 1, 2001 and the Supported Services waiver will be submitted by October 1, 2001.
     
  7. Staff resources within FSSA need to be strengthened, particularly in the areas of management training for supervisors and to increase analytical capacity and the capacity for developing new initiatives, for quality assurance improvements and for case management resources. Responsibility: FSSA Secretary’s Office Timeline: A plan will be in place by January 1, 2002.
     
  8. DDARS is strengthening its intensive crisis services for persons with developmental disabilities. This involves two separate strategies. One is for immediate access to placement outside of the individual’s current environment, for example an inpatient setting or some other type of approved placement. An individual who was placed temporarily outside the current environment would receive all needed services as part of the crisis assistance – room/board, supervision, medication, therapies, living skills training, etc. The second strategy is for immediate access to crisis assistance within the consumer’s current home environment, when this is appropriate. A separate contract would be developed for services to be delivered by the crisis specialist. The individual’s other services would continue to be delivered and reimbursed as usual, if needed. Responsibility: DDARS. Timeline: Phase One of plan to be implemented by December 31, 2001.
     
  9. Determine whether the full continuum of care is available in all geographic areas of Indiana for children and adolescents. Responsibility: DMHA. Timelines: September 2002.
     
  10. The DMHA will insure that provider payment rates are adequate. Actuarial study for services to adult is scheduled for Spring 2002; study for services to children is scheduled for Spring 2003. Responsibility: DMHA. Timeline: Spring, 2003.
     
  11. Increase options for Addiction Treatment using new technologies. Research new technologies and explore feasibility of implementing a pilot. Responsibility: DMHA. Timeline: Complete feasibility study by June 2002.
     
  12. The budget approved for the next biennium includes $10 million over the two years in additional funds for community services for adults with serious mental illness, and $2.5 million each year for services in the community for Seriously Emotionally Disturbed Children. Responsibility: DMHA. Timeline: Fiscal Years 2002 and 2003.
     
  13. The budget approved for the next biennium includes $3 million in additional funds annually for Vocational Rehabilitation Services. This will enable Indiana to fully match available federal funds for this program, leveraging additional federal funds of $12.7 million. It allows services to over 5,700 individuals with disabilities in achieving and maintaining self-sufficiency. Responsibility: DDARS. Timeline: Fiscal Years 2002 and 2003.

Policy Direction # 6: Create a coordinated workforce development system that recruits and supports a stable resource of direct support staff.

In order to meet the needs of current and future numbers of persons with disabilities needing supports and services so they can live and work in communities, the pool of workers with sufficient skills and training needs to significantly increase. It is important that the State take steps to ensure a stable and motivated workforce.

Recommendations:

  • Provide means for training and certification of persons providing direct services.

Action Steps, Goals and Timelines Related to Policy Direction #6

  1. The Bureau of Quality Improvement Services (BQIS) of DDARS is developing provider standards. These standards will assist DDARS and provider agencies in supporting, training, and directing direct support staff. Preliminary Provider Standards for all individuals with developmental disabilities will be included in contracts that go into effect on July 1, 2001. This includes services provided through the DD, Autism and Aged and Disabled Waivers and all services provided through the BDDS (Respite, Day Services, etc.). There will be a six month trial period, with the final Provider Standards being published in the Indiana Register on March 1, 2002. Responsibility: DDARS. Timeline: Will be promulgated by 12/31/2002.
     
  2. Funds have been included in the budget approved by the legislature for a rate increase targeted to direct care workers. The rate increase affects providers of services through CHOICE, waiver and BDDS services. Responsibility: DDARS. Timeline: Will begin by October 1, 2001.

  1. Going Forward

A plan is a design for making change. In order to be effective, a plan must contain mechanisms that:

  • Create and effect the long term policies that undergird substantive change;
  • Monitor change that is taking place; and
  • Ensure that change is integrated into the perceptions and actions of those affected by change.

This Plan proposes a Governor’s "Real Community Choice" Commission and systems change demonstration projects to promote, manage and sustain the community integration process.

A. Establishment of a Governor’s "Real Community Choice" Commission

An integral part of making this plan work will be consistent consumer and advocate input, as well as bringing agencies throughout State government together to discuss issues and find solutions to the problems that inhibit community integration. In order to accomplish this, we recommend that Governor O’Bannon establish a "Real Community Choice" Commission, bringing together the various constituencies both influenced by and influencing this plan. Membership should include consumers of community-based and institutional services; legislators; advocacy groups; and State agencies, including the FSSA, the State Department of Health, the Department of Transportation, the Department of Commerce and the Housing Finance Authority, among others.

The goal should be to provide on-going leadership for community integration, on-going public discussion of this plan and its desired outcomes, and a mechanism for consistent quality assurance as more individuals leave traditional long-term care settings and move to or stay in the community. Also, the Commission should communicate with the public on progress through newsletters and regular written progress reports. It is recommended that the Commission be attached to the Governor’s Office, in order to hold all agencies involved in implementing community integration activities accountable to the Governor.

B. Real Choice Systems Change Grants and Systems Change Demonstration

One of the first duties of the commission could be overseeing the State’s responses to a series of grants for which the state may apply from the Health Care Financing Administration. These include the Real Choice Systems Change Grant, the Nursing Home Transitions/Access Housing 2001 Grant and the Community-Based Personal Assistance Grant. The Real Choices grant is intended to help design and implement ways of providing community supports and services to enable children and adults of any age who have a disability or long term illness or disability to live and participate in their communities. The Nursing Home Transitions grant is to help eligible individuals make the transition from nursing facilities to the community. Grant funds provided by the Community-Based Personal Assistance grant may be used to develop infrastructure to provide services that are consumer-directed or offer maximum individual control.

In order to both maximize funding available and achieve true systems change, the State should integrate all three grants in a series of demonstration projects. This venture would bring together state- and local-level representatives in community partnerships to create a new method of providing care to individuals in need of service. The goal should be to provide a system of strategic supports to allow communities to achieve success in community placement. The five areas for strategic supports include: 1) Systems Supports, 2) Community Supports, 3) Consumer Supports, 4) Family/Caregiver Supports, and 5) Provider Supports.

Systems Supports

Systems change begins with examining and transforming the overarching mechanism for providing services. The grants will help transform the system in a number of ways. First, the Governor’s Real Community Choice Commission should allow for individuals from a variety of viewpoints to come together and discuss the strengths and weaknesses of the current system. The Commission could then be in a position to recommend and monitor changes to the system. Also, the Commission would provide for on-going dialog regarding the success of both the demonstration project as well as the overall long-term plan. The Commission should also continue to have regular meetings throughout the state to report on the progress of the plan, to listen to concerns and to receive input.

A second system support, very critical to the success of community integration efforts, should be the creation of locally based projects that bring together consumers and advocates, individuals representing providers in the area, local policy makers and the local offices of state agencies. These Local Planning Groups should be charged with the task of planning local innovations which provide better supports for persons with disabilities in the community.

A third component of systems supports is the providing of information to consumers and their families, as well as policy makers. A portion of the Real Choices grant could be utilized to explore software programs that provide a comprehensive solution to this need for information. One software system, known as the DANIC system, would allow FSSA to collect information on provider agencies. This system would also permit families to find information on providers and to communicate with each other. It would also let FSSA demonstrate to legislators and other interested parties where funding is going and successes that the funding is providing.

Community Supports

In order to allow individuals to succeed in the community, a number of community supports must be put in place. It is clear that individuals require good, dependable transportation resources, accessible housing and employment options. Furthermore, individuals need easy access to the myriad of services available, as well as information about these services. The demonstration projects should focus on bringing community and business support together with state and federal resources to provide for these needs. Co-location of state services, partnerships with businesses and engaging providers to help transform services will be a starting point for providing community supports.

Consumer Supports

Individuals will need personal help to succeed in the community. One of the major components of this project should be to provide for consumer-directed care. Individuals who are properly qualified should be allowed to hire their own providers, even non-traditional providers such as neighbors or classmates. A system must be developed to aid this.

Senate Bill 215, recently passed by the General Assembly and signed by Governor O’Bannon provides a perfect starting place for this project. This bill requires the DDARS to create and maintain a registry of Personal Services Attendants who provide attendant care services. This registry will allow for individuals CHOICE and the Medicaid Waiver program to hire these registered attendants. Furthermore, it will make this list available to individuals requiring Personal Assistance through the Vocational Rehabilitation program or through private-pay.

House Bill 1767, also approved during the most recent legislative session, will expand options of care available to individuals. By September 30, 2001, the Office of the Secretary must file a preliminary report of a plan to assure that services provided to elderly or disabled individuals who are eligible to receive services from FSSA match the needs of those individuals as closely as possible. The plan must include specific options available from least restrictive to most restrictive, the costs of such care, the availability of waivers through the Medicaid program, and the effects on the quality of life for the individual, the families of the individual, the state budget and the state’s economy. A final report is due by June 30, 2002.

Other areas of concern in providing for consumer supports include assuring quality, as well as protection and advocacy. The grants should help address the critical areas of case management and management of the waiting list for services. It should also help determine individuals who could readily move from institutions into the community. This most likely includes people who already have family and other community resources.

Family/Caregiver Supports

There are a number of people who could either continue to live in the community, or move back home if their families and other caregivers had adequate supports. The demonstration projects should focus on providing assistance to families and other caregivers. Many people caring for their loved ones need Respite and/or Crisis Assistance. This endeavor should examine ways of expanding these services and raising awareness of their availability. Continual information and assistance are critical to the success of families providing services in the community. Also, it is important to provide mechanisms for on-going support and involvement for both the individuals needing care and the people providing that care.

Provider Supports

None of the supports mentioned above will be successful without a strong partnership with providers. The demonstration projects should focus on strengthening this partnership. Some of the issues to be addressed are personnel issues, including staffing shortage and lack of adequate training and wages which impact providers’ ability to hire and keep high-quality workers.

The project must also look at how to break down the barriers to becoming a provider, as well as providing for a "Fiscal Intermediary" to allow for non-traditional providers (friends, neighbors, etc.). Most importantly, both the Commission and the Local Planning Groups must be ready to listen to providers’ concerns and suggestions in order to allow for the successful provision of community services.

Another important component of the Real Community Choice Commission will be the establishment of Task Forces focused around the Strategic Support areas outlined above as well as a Consumer Task Force. Only through on-going communication with the public at large will true systems change take place.

Conclusion:

The heart of any plan is the support of the persons affected in implementing the plan and in further modifying its principles to meet the changing needs of the future. We are satisfied that the process of developing this Plan has energized persons with disabilities, their families, advocates and providers across Indiana. Through two series of public meetings, advisory committees and other exchanges, FSSA heard persons with disabilities and those close to them and initiated a dialogue which should continue through the Governor’s Commission and local collaborative efforts between consumers, their families, government, providers and advocates. FSSA looks forward to expanding and deepening the dialogue to ensure the community integration of all Hoosiers who can benefit.