Both 2014 and 2015 have been pivotal years for advocates who are trying to make strides toward increased community integration and engagement. There are important questions on “How”, that still remain for providers and local boards alike, but those questions have not stopped the progress of rules and legislative activity.
Over the past few weeks several articles have been published that address the same common thread; the local county board’s workshop programs for people with developmental disabilities and their inherent conflict of interest. Interestingly, though, the articles come to different conclusions.
Reflecting on the past several years, there has been a strong push to no longer define community integration as how many “outings” someone has gone on, but rather what kinds of meaningful life experiences are being offered. Many advocate groups support such an effort in general. Of course we want to see more individuals with developmental disabilities in the workforce and yes we want to see schools involved in vocational training earlier on, but concerns for a persons well being and safety usually creates a sticking point. Our system has made it very difficult for a person with a developmental disability to make decisions and take actions when there is a potential risk tied to those actions.
Advocate groups generally are torn here as well. It’s been my experience with families, that have been advocating a long time, and engaged with the social service system, tend to get very concerned when changes to the bedrock of their advocacy efforts are discussed. It’s easy to forget why they may feel so strongly, but there is a story, usually very personal, with lots of emotion that will not, and should not be easily forgotten. Parents and/or advocates have gone through immense personal sacrifice and pain to secure, what at the time was considered, non-institutional based services for their sons and daughters. Their legacy has been the civil rights of people with developmental disabilities and the drastic reduction of abuse and neglect in care.
So why must the system that we have grown comfortable with transition into something new? People do recognize that discrimination at school or the workplace continues to exist, and we are not providing the same opportunities to our students and citizens with disabilities. Ohio’s Project Transformation project and its formal plan to address CMS guidelines regarding integrated services and inherent conflicts of interest in our system are significant public policy shifts.
Project Transformation 2.0 – New Paths to Employment
In April 2014 Project Transformation was initiated, and seven county boards and three private providers were selected to participate from the application process. This was a cooperative effort with the Ohio Department of Developmental Disabilities and the Employment First Task Force. You can view the providers selected, their plans for transformation and preliminary transition steps on the Employment First website. In November 2014 a group of leadership mentors were delegated for Ohio to move from facility-based programs to more integrated settings. 2015 came the introduction of Project Transformation 2.0.
Project Transformation 2.0 teams were supported through the Employment First State Leadership Mentor Program coordinated by the Office of Disability Employment Policy.
With the assistance of the leadership mentor group, eight providers were selected for technical assistance to move their service delivery to an integrated setting. Transformation plans have been created for the selected providers with three year goals set. It appears the plans are just now being finalized and are available for review. All plans are focused on providing services in a different manner, by increasing community integration across settings and increasing employ-ability of people with developmental disabilities.
Conflict of Interest and County Boards as Employment Providers
At the same time that Project Transformation created a lot of discussions around the service delivery model, something else was challenging who could provide the service in the first place. New guidelines from the Federal government were released in 2014 and they included clearer parameters regarding Conflict of Interest. The Centers for Medicaid and Medicare (CMS) is prohibiting the Local County Board system from being both the providers and the case manager responsible for oversight. This rule was put under much scrutiny by the state, which asked CMS for a deadline of compliance extension. Originally CMS asked for Ohio to come into compliance within 5 years. Ohio requested an extension for 2024 compliance (9 years) in which CMS agreed.
Currently there are 88 county boards, all in which provide case management. Ohio Department of Developmental Disabilities has placed a benchmark that
by March 2020, no more than 30% of individuals receiving case management from the county boards may be receiving HCBS by the county boards.
For Adult Day Services and Non-Medical Transportation alone, currently 48.25% of services are provided by county boards of DD rather than private providers. Most recently two county boards, Butler and Athens County, have given notice to their stakeholders that they will be pulling out of direct service delivery by 2024.
In conclusion, with both Project Transformation (1.0 and 2.0) and the Conflict of Interest guidelines, we are starting to see movement in how services are delivered directly at the county board level and a paving the way for private agencies to provide more of the services in our system. This is a moment in time that we need to reflect on where we have come and where we are going. None of us should be defined by our past, but it should help inform our discussion and help to sustain our communities.