15 Answered Questions from DDS
At the Intellectual and Developmental Disabled (I/DD) Legislative Caucus meeting on Aug. 12, Rep. Jay Case invited parents and families to submit questions for the state Department of Developmental Services (DDS) through him and the I/DD Caucus.
Below is the first round of questions families submitted to Rep. Case through The Arc Connecticut.
Rep. Case encourages parents & families to continue to submit questions for DDS to at jay.case@housegop.ct.gov or to The Arc’s Shannon Jacovino at sjacovino@thearcct.org.
The Arc Connecticut will continue to post unedited questions and answers for all families to view and share.
1.Why can’t federal matching funds go into the DDS instead of the General Fund?
DDS Response: The full cost of these programs is state funded through an appropriation to the DDS. If all conditions of Medicaid participation are met, the state is reimbursed by the Centers for Medicare and Medicaid Services (CMS) for approximately 50% of the cost. This revenue is deposited into the General Fund and is included in the state’s quarterly consensus revenue estimates. This and all other state revenues (taxes, fees, etc.) are factored into the state budgeting process to cover necessary state expenses.
2. Beyond the one “tech home” in Meriden, what new assistive technology is being used now to help our children become more independent? Where can families get more information on this?
DDS Response: Families can go the Assistive Technology website to find out more information: http://www.cttechact.com/. This website provides information about the five technology sites in Connecticut where families can go to talk to experienced staff about technology and see it. DDS is also in the process of developing a technology brochure for individuals and families which should be available on the DDS website in September. DDS’s Employment Technology pilot, which will be completed in December 2014, will be producing material on technology success stories. The Community of Practice technology committee is working on developing technology videos which will showcase other technology stories.
Families can also view technology success stories on the Sengistix website at http://web.inarf.org/Associate-Member/Sengistix-LLC-116 and by visiting the Assistive Living Technology store in Meriden: http://www.assistedlivingtechnologies.com/.
Several private agencies have begun using or exploring many technology options. Among them are Oakhill (NEAT Marketplace), Marrakech, and Arc of Meriden Wallingford. A great web link to get started exploring technology is http://www.qualitymall.org/directory/dept1.asp?deptid=94 is also great resource for families to explore other person-centered services beyond technology.
3. If a family of an individual who is a P1 on the waiting list accepts “in home supports” would this individual be taken off the P1 list?
DDS Response: Yes, if the individual’s needs are met they are taken off of the Waiting List. If the person accepts $20,000 or more of in-home or other residential supports, but their needs are still not fully met, or they continue to want an out of home placement, then they are designated an Emergency or Priority One on the Other Residential Needs List which is also tracked quarterly in the DDS Management Information Report (MIR). Being on the Other Residential Needs List means an individual is getting a significant amount of resources (at least $20,000) but DDS has acknowledge they need more than what they are currently getting.
While individuals on the Other Residential Needs List are not included in the Waiting List numbers, an individual who is living at home and receiving a significant amount of services may still be classified an Emergency or Priority One if they have a priority need for significant additional services.
Again, to be an Emergency or Priority One on the Waiting List, a person must be receiving less than $20,000 of in-home supports. Many individuals on the Waiting List are receiving no residential supports or services. Please note that funding received for an individual’s day program does not impact their status on the waiting list.
4. Are there any individuals who were on the P1 waiting list whose names have been taken off the P1 list because they are receiving “in home supports”?
DDS Response: Yes, if their identified need has been met they are taken off of the Waiting List. If that need is no longer met, if a new need arises, or if a living situation or family dynamic changes they can go back on the Waiting List. To be an Emergency or Priority One on the Waiting List, a person must receive less than $20,000 of in-home supports. If the person receives more than $20,000 of in-home or other residential supports, but their needs are still not fully met, or they continue to want an out of home placement, then they are designated an Emergency or Priority One on the Other Residential Needs List. Again, this acknowledges that they need more than they are currently getting, but distinguishes them from other individuals who have no residential services (less than $20,000).
5. If the answer to 3&4 is yes, then what is the status of those individuals? Are they P2s, P3s? And please define the type of supports that would change an individual’s status.
DDS Response: If their need is fully met by the in-home supports, then an individual is taken off of the Waiting List. It is not based on the type of supports, but rather on whether an identified need is met or not met and what the planning goals are for the individual. Please see the responses to questions #3 and #4 as to what triggers a change in Waiting List status. To be clear, DDS has always considered individuals receiving annualized residential funding as no longer on the Waiting List if their needs are met, regardless of setting, including family homes.
6. What criteria will DDS use to determine which families will receive funding from the $4 million the legislature appropriated for the waiting list?
DDS Response: Of the approximately 160 families identified as individuals on the Waiting List with caregivers age 70 or older by July 1, 2014, 19 families have declined services, mostly because they do not yet need additional supports or they have already arranged an alternate plan. Of the remaining families, DDS has already begun to plan and initiate services for 11 individuals with the most emergent need and is in the process of notifying another 38 individuals and their families that they will receive funding and planning will be initiated in the first half of fiscal year (FY) 2015.
Once DDS services have been initiated for this group of individuals, and FY15 costs are more concrete, DDS will start planning for the next group of individuals from the list with the most need. Prioritization within the list of 160 individuals identified is decided based on conversations with these families, the needs of the individual, caregiver capacity to support the individual, and availability of natural supports. DDS is confident that the needs of at least 100 families will be addressed with the $4 million dollars. Because funding was for a half year in FY15, the start dates of these services will be staggered through the fiscal year.
7. What percentage of the $4 million will DDS use for in home supports instead of residential placements?
DDS Response: The final breakdown is still uncertain because we are engaging in person-centered planning with each of the families and funding allocations will be based on level of need, however, approximately half, or 50%, of the individuals who meet the criteria for funding and want services have requested in-home supports and half have requested out-of-home supports.
8. Is there any mechanism or way DDS can use monies not spent in the DDS budget to serve more people?
DDS Response: DDS is always trying to stretch its budget allocations as far as possible. DDS is engaged with multiple stakeholders to create new ways to increase the number of people served within the same allocations. DDS has a long history of providing most of its residential supports through either group homes or institutional settings. Both of these types of settings represent some of the most expensive models possible. Over the last three years, the department has engaged with a wide variety of stakeholders to explore alternative ways to provide residential supports. Some agencies that are part of the Living the Mission Mentoring Project have already begun to reshape their services as they implement person-centered supports to individuals who they serve. The broader conversion of programs throughout the state will take time.
9. When will the individuals who are entitled to the $4 million in waiting list funds be notified of their status?
DDS Response: Notifications have begun and will continue throughout this fiscal year.
10. When will those individuals who are chosen begin receiving supports?
DDS Response: Please refer to #6.
11. Will any of that funding be used for people requesting group homes, or support in apartments with other I/DD roommates or will DDS only fund in home supports and Community Companion homes?
DDS Response: Yes, DDS’s full spectrum of supports are available to families including, but not limited to, Community Living Arrangements (CLAs) or group homes, Continuous Residential Supports (CRSs), Community Companion Homes (CCHs), live-in companion models, and individualized home supports with family, in family or own homes, or in apartments. Services are available through self-determination or self-hire or through a private provider agency. Individualized supports will be developed based on family preferences and the individual’s level of need (LON).
12. When will DDS begin implementing “lifespan” services? My son is 19 and we haven’t seen or heard from our Case Manager.
DDS Response: The goal of the DDS lifespan approach is to assist individuals to achieve self-determination, interdependence, productivity, integration and inclusion in all facets of community life and to assist families to support their children in ways that maximize their capacity, strengths, and unique abilities to best nurture, love, and support the individual to achieve their goals.
The lifespan approach is not a new service that will be offered to families. It is a new way to partner with consumers, families, providers, other state agency staff and community members to help families build upon their strengths and to use self-advocacy and self-determination skills to build a better life. It is also a new strategy to use to help build better partnerships with communities so that people with disabilities have more opportunities to be included in their communities as productive contributing citizens.
DDS provides various services for individuals with intellectual disability or autism across the lifespan. For individuals between the ages of 4-21, supports are often coordinated between DDS, the Department of Children and Families (DCF), the Department of Social Services (DSS), and the local education agency (LEA) for the school where the child attends.
13. When will DDS begin creating or offering more creative housing options?
DDS Response: DDS currently has a number of housing options available to individuals with intellectual disability. These include CLAs, CRSs, CCHs, and Individualized Home Supports while living with their family, or living on their own. People may hire a private agency to provide Individualized Home Supports or directly hire support staff with a Fiscal Intermediary handling the payments and accounting.
DDS is currently in the process of requesting an amendment to allow shared living as an option under the waivers. A subcommittee of the Community of Practice has been created to research other housing options that might be available to DDS consumers in the future.
There is currently no timetable as to when any of these new residential settings will be available as a support option, but the committee should begin to narrow down the options over the coming year.
Additionally, there are a small number of limited innovations currently underway, with discussions from a person-centered perspective for a number more. There is no ‘super model’ of new services that will fix everything. Planning on an individual basis while creating flexibility within our existing funding and service model definitions is a time intensive process. Establishing creative housing options is a national issue, and Connecticut is a leader in this process.
14. What is the DDS timeline for implementing Community of Practice (CoP)? How will CoP be used to assist the current ‘haves’ and to assist the ‘have nots’?
DDS Response: The Integrated Supports Model promoted by the Supporting Families Community of Practice will help all stakeholders to think about and experience a variety of types of supports that can be provided for individuals supported by DDS. This broadened vision of supports, which includes supports beyond what DDS can provide, will help families who don’t get services from DDS and will help those families who do receive services to reduce their reliance on what DDS does provide. It will take time for this new vision of support to be fully understood and adopted by stakeholders. It is anticipated that younger families who have not been embedded in the traditional way of thinking about supports will have an easier time adapting to this new model of services. It will take time for this new way of providing supports to mature in a way that allows all families to benefit from this new way of providing supports.
15. Beyond providing residential placement & support for those people who are eligible to receive the $4 million in funding for the waiting list, what is DDS’ long term plan to begin addressing the needs of other individuals who are waiting for residential placement?
DDS Response: DDS’s Five Year Plan addresses 25 goals of the department aimed at examining better ways to support individuals with less expensive natural, family, and community supports and seeking to do the most good for the largest number of people with the resources allocated by the state.
The Integrated Supports Model promoted by the Supporting Families Community of Practice is a new framework that helps families to think about a variety of different types of supports that can be used to help individuals live a successful life.
Limited availability of funding and resources require families to find creative new ways to support their child. The Integrated Supports model provides some new ideas that families will want to consider as other more traditional types of supports become less available due to the rising levels of competing need that is occurring as individuals get older and as the number of people with disabilities continues to grow.
Additionally, DDS is engaged with private providers in a Living the Mission mentoring project. This mentor opportunity offers a supported way for Connecticut’s community of providers to learn from nationally recognized mentors how to better align their agencies to support individuals and families to develop person-driven residential supports. Also, DDS is most cognizant of the driving force of CMS who seeks to ensure that all DDS supports are person-centered in nature over time. Any large scale expansion of services would require additional authorization of fiscal resources.