>> SLIDE 1 What Does Person-Centered Planning Mean for the IL Paradigm? CMS has released guidelines on person-centered planning. When they were released, a lot of people in IL were concerned with how in-line this rule is with IL values and practice. The format of this presentation is as follows: - The first bullet is a one sentence or guideline from the rule. - The second bullet indicates that it is part of person-centered language (they all fit into that category, so there is a "Yes" in each). - The third bullet indicates whether it is also in line with IL values. If there is a question mark, it means that either there is more information needed, or it is mostly consistent with IL but needs to go further. - The fourth bullet is alternative language that would be more in-line with IL. Logos: Independent Living Center of the North Shore and Cape Ann, National Council on Independent Living, Administration for Community Living, Centers for Medicare and Medicaid Services >> SLIDE 2 - Mary Margaret Moore, Executive Director of the Independent Living Center of the North Shore and Cape Ann, Inc., President of the ADRC of the North Shore and Cape Ann, Inc., and Co-chair of the NCIL ADRC Task Force: Mmmoore@ilcnsca.org - Shawn Terrell, Health Insurance Specialist, Administration on Community Living: Shawn.terrell@acl.hhs.gov - Linda Joyce, Deputy Director, Division of Long Term Services and Supports, Center for Medicare and Medicaid Services: Linda.Joyce2@cms.hhs.gov >> SLIDE 3 Rule language: The person-centered planning process is driven by the individual. Person-Centered: Yes IL Philosophy: Yes IL value - Consumer driven: The consumer will initiate, choose their goals, choose their process, and choose their options. >> SLIDE 4 Rule language: The process: (1) Includes people chosen by the individual. Person-Centered: Yes IL Philosophy: Yes IL value - Peer from CIL with them, if they want. >> SLIDE 5 Rule language: The process: (2) Provides necessary information and support to ensure that the individual directs the process to the maximum extent possible, and is enabled to make informed choices and decisions. Person-Centered: Yes IL Philosophy: Yes IL value - Consumer shall receive accurate, relevant, viable information in a mode and rhythm and style and language that meets their need for making their choices for how they are to live independently. >> SLIDE 6 Rule language: The process: (3) Is timely and occurs at times and locations of convenience to the individual. Person-Centered: Yes IL Philosophy: Yes IL value - Consumer determines frequency, mode and sites for. >> SLIDE 7 Rule language: The process: (4) Reflects cultural considerations of the individual and is conducted by providing information in plain language and in a manner that is accessible to individuals with disabilities and persons who are limited English proficient. Person-Centered: Yes IL Philosophy: Yes IL value - [blank] >> SLIDE 8 Rule language: The process: (5) Includes strategies for solving conflict or disagreement within the process, including clear conflict of interest guidelines for all planning participants. Person-Centered: Yes IL Philosophy: Yes IL value - The consumer is the decision-maker. While others in the process may provide input, the consumer drives the process, with exploration of multiple viable options, and makes the decisions. >> SLIDE 9 Rule language: The process: (6) Offers choices to the individual regarding the services and supports the individual receives and from whom. Person-Centered: Yes IL Philosophy: ? IL value - Supports/services may be offered to the consumer, however the options must not be restrictive and must not be limited to a predetermined list. >> SLIDE 10 Rule language: The process: (7) Includes a method for the individual to request updates to the plan, as needed. Person-Centered: Yes IL Philosophy: ? IL value - The plan is an ongoing process that can be changed and updated whenever the consumer decides. >> SLIDE 11 Rule language: The process: (8) Records the alternative home and community-based settings that were considered by the individual. Person-Centered: Yes IL Philosophy: ? IL value - Process of decision-making may or may not be important for consumer to have recorded, it is consumer choice as to what is recorded. >> SLIDE 12 Rule language: The person-centered service plan must reflect the services and supports that are important for the individual to meet the needs identified through an assessment of functional need. Person-Centered: Yes IL Philosophy: ? IL value - Services and supports that are important TO/BY the individual must be reflected, and are not necessarily related back to a functional assessment. >> SLIDE 13 Rule language: …as well as what is important to the individual with regard to preferences for the delivery of such services and supports. Person-Centered: Yes IL Philosophy: ? IL value - It is always driven by consumer preferences unless not available to anyone. >> SLIDE 14 Rule language: The written plan must: (1) Reflect that the setting in which the individual resides is chosen by the individual. The State must ensure that the setting chosen by the individual is integrated in, and supports full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community to the same degree of access as individuals not receiving Medicaid HCBS. Person-Centered: Yes IL Philosophy: ? IL value - The supports and services must reflect that the setting in which the individual resides is chosen by the individual, and that the individual is fully supported and integrated in the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community. However, these items are only included in the plan if they are areas which the consumer decides they need additional support or services. >> SLIDE 15 Rule language: The plan must: (2) Reflect the individual’s strengths and preferences. Person-Centered: Yes IL Philosophy: Yes IL value - Only if consumer is in agreement to have these recorded. >> SLIDE 16 Rule language: The plan must: (3) Reflect clinical and support needs as identified through an assessment of functional need. Person-Centered: Yes IL Philosophy: ? IL value - Reflects support needs as identified by the consumer and those accepted from others by consumer. >> SLIDE 17 Rule language: The plan must: (4) Include individually identified goals and desired outcomes. Person-Centered: Yes IL Philosophy: Yes IL value - Consumer chooses their goals, unless they waive a plan, then it is done by Peer Guide, letting consumer see the goals. Waiver of plan must be signed. >> SLIDE 18 Rule language: The plan must: (5) Reflect the services and supports (paid and unpaid) that will assist the individual to achieve identified goals, and the providers of those services and supports, including natural supports. Person-Centered: Yes IL Philosophy: Yes IL value - Consumer chooses their services and supports and natural supports, if consumer wishes. >> SLIDE 19 Rule language: The plan must: (6) Reflect risk factors and measures in place to minimize them, including individualized backup plans and strategies when needed. Person-Centered: Yes IL Philosophy: ? IL value - The consumer is allowed to choose services and supports to meet their personal goals. Consumers have the ‘right to fail’ just as individuals without disabilities do. >> SLIDE 20 Rule language: The plan must: (7) Be understandable to the individual receiving services and supports, and the individuals important in supporting him or her. At a minimum, for the written plan to be understandable, it must be written in plain language and in a manner that is accessible to individuals with disabilities and persons who are limited English proficient, consistent with §435.905(b) of this chapter. Person-Centered: Yes IL Philosophy: Yes IL value - It is the consumer’s plan, in their language, mode, style. >> SLIDE 21 Rule language: The plan must: (8) Identify the individual and/or entity responsible for monitoring the plan. Person-Centered: Yes IL Philosophy: ? IL value - The consumer is the responsible entity for determining whether his/her needs are being met. >> SLIDE 22 Rule language: The plan must: (9) Be finalized and agreed to, with the informed consent of the individual in writing, and signed by all individuals and providers responsible for its implementation. Person-Centered: Yes IL Philosophy: ? IL value - The plan is not intended as a contract between the individual and their ‘person-centered counselor’, but rather is a set of plans and contracts with service providers. >> SLIDE 23 Rule language: The plan must: (10) Be distributed to the individual and other people involved in the plan. Person-Centered: Yes IL Philosophy: Yes IL value - All with consumer permission, and if not with written permission, then not distributed. >> SLIDE 24 Rule language: The plan must: (11) Include those services, the purchase or control of which the individual elects to self-direct, meeting the requirements of §441.740. Person-Centered: Yes IL Philosophy: Yes IL value - The consumer will self-direct all of the services and supports they receive if they desire to do so. >> SLIDE 25 Rule language: The plan must: (12) Prevent the provision of unnecessary or inappropriate services and supports. Person-Centered: Yes IL Philosophy: ? IL value - The consumer decides which services and supports are appropriate for their needs, except for specific public programs that have specific eligibility requirements. >> SLIDE 26 The following slides address how consumer rights are protected and what must be in place by residential providers when corporate liability comes into question so that limitations on consumers choices are considered. >> SLIDE 27 Rule language: The plan must: (13) Document that any modification of the additional conditions, under §441.710(a)(1)(vi)(A) through (D) of this chapter, must be supported by a specific assessed need and justified in the person-centered service plan. Person-Centered: Yes IL Philosophy: ? IL value - All needs are self assessed with information from other sources shared with consumer, and only if consumer agrees it is a need is it added to their plan. >> SLIDE 28 Rule language: The following must be documented in the plan: (i) Identify a specific and individualized assessed need. Person-Centered: Yes IL Philosophy: [blank] IL value - Only if consumer chooses. >> SLIDE 29 Rule language: The following must be documented in the plan: (ii) Document the positive interventions and supports used prior to any modifications to the person-centered service plan. Person-Centered: Yes IL Philosophy: [blank] IL value - Any modifications that the consumer prefers can be made at any time. >> SLIDE 30 Rule language: The following must be documented in the plan: (iii) Document less intrusive methods of meeting the need that have been tried but did not work. Person-Centered: Yes IL Philosophy: [blank] IL value - Only if consumer chooses, as this can be looked at as failure. >> SLIDE 31 Rule language: The following must be documented in the plan: (iv) Include a clear description of the condition that is directly proportionate to the specific assessed need. Person-Centered: Yes IL Philosophy: ? IL value - Consumer must be the definer of the conditions being put in place in provider owned or controlled settings. >> SLIDE 32 Rule language: The following must be documented in the plan: (v) Include a regular collection and review of data to measure the ongoing effectiveness of the modification. Person-Centered: Yes IL Philosophy: [blank] IL value - Consumer provides feedback if the service or modification is no longer effective. Checking in with the consumer is only to assess consumer satisfaction and/or additional needs. >> SLIDE 33 Rule language: The following must be documented in the plan: (vi) Include established time limits for periodic reviews to determine if the modification is still necessary or can be terminated. Person-Centered: Yes IL Philosophy: [blank] IL value - Consumer determines time limits and need for changes. >> SLIDE 34 Rule language: The following must be documented in the plan: (vii) Include informed consent of the individual. Person-Centered: Yes IL Philosophy: [blank] IL value - The plan does not serve as a contract between the counselor and the consumer; rather it is a set of decisions and service contracts between the consumer and service/support providers. >> SLIDE 35 Rule language: The following must be documented in the plan: (viii) Include an assurance that the interventions and supports will cause no harm to the individual. Person-Centered: Yes IL Philosophy: Yes IL value - Allow consumers to assume the same right to fail as individuals without disabilities have. >> SLIDE 36 Rule language: Reviewing the person-centered service plan: The person-centered service plan must be reviewed, and revised upon reassessment of functional need as required in §441.720, at least every 12 months, when the individual’s circumstances or needs change significantly, and at the request of the individual. Person-Centered: Yes IL Philosophy: [blank] IL value - The plan is reviewed when the consumer has determined that they need or want it to be reviewed, either to modify, add, or get rid of supports or services. This is done at least every six months, more frequently as consumer discusses/shares changes he/she needs. >> SLIDE 37 Websites NCIL: www.ncil.org Independent Living Center of the North Shore & Cape Ann, Inc.: www.ilcnsca.org ADRC of the North Shore & Cape Ann, Inc.: www.adrcgns.org Administration on Community Living: www.acl.gov Center for Medicare & Medicaid Services: www.cms.gov >> SLIDE 38 Resources NCIL ADRC Task Force: www.ncil.org/adrctf NCIL’s ADRC Position Paper: www.advocacymonitor.com/ncil-policy-on-aging-and-disability/ncil-position-paper-aging-and-disability-resource-centers-adrcs Link to the HCBS Regulations and accompanying documents: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Home-and-Community-Based-Services.html HHS Person Centered Planning and Self-Direction standards/ blog: www.acl.gov/NewsRoom/blog/2014/2014_07_09.aspx Julia Sain’s Person-Centered vs. Consumer-Controlled video: https://www.youtube.com/watch?v=c18bi7V0G90&feature=youtu.be For a copy of these slides: Lindsay@ncil.org >> END PRESENTATION