Concept Paper Overview

Presentation to the 1102 Task ForceJanuary 7, 2020

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What is a Concept Paper?

• Technique states commonly use to share ideas for

significant changes to their HCBS waivers or other

programs with stakeholders and CMS

• Opportunity to get feedback and refine plans based on

the input of stakeholders

• Nothing presented in this concept paper is final,

decisions for how to proceed will come later

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Overall Approach & Purpose

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Starting Place

• Public Input• Promising

Practices• Current System

Guiding Values

• LifeCourse• Project Team

Principles

• DDRS Goals

Initial Concept Paper

• Share Ideas• Provide Context and

Considerations• Facilitate Feedback• Inform Waiver Design

Informed Path

Forward

• Final Concept Paper

• Waiver Development

• Rate Methodology

Concept Paper Structure

• Two “Versions”

• Full Report with Appendices

• Shorter Summary

• Each Section Includes “Key Questions” for Readers to

Use as Their Guide to Share Thoughts and Feedback

• Feedback not limited to these questions

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Concept Paper Outline

• Laying the Foundation

• DDRS Goals and Guiding Principles

• Background

• Considerations and Guiding Questions

• Vision for Redesign

• Structural Elements

• Service Changes

• Quality Measures

• Other Improvement Efforts

• Underpinnings of the Approach

• The Path Forward

• Appendices

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Laying the Foundation: DDRS Principles

Increase Person-Centered Planning

Improve Coordination of Care

Increase Community Engagement

Enhance Member Experience

Maintain Qualified Providers

Comply with HCBS Rule

Promote Efficiency

Background

• DDRS sought expert assistance with waiver redesign

in September 2018

• Kick-off meeting held with HSRI and project team in

April 2019

• National and Indiana context for transformational

change

• Tasks completed to date

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Vision for Redesign

• Structural Elements

• Service Changes

• Quality Measures

• Other Improvement Efforts

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Structural Elements

Path #1: Two Waivers

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Waiver 11915 (c)

All Eligible Individuals

Waiver 21915 (c)

All Eligible Individuals

• Builds on the familiarity of the current two waiver structure

• Presents modest series of changes

• Infuses LifeCourse principles into an enhanced service array

• Provides some opportunity for utilizing self-directed option

Structural Elements

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Waiver 11915 (c)

All Eligible Individuals

Waiver 21915 (c)

All Eligible Individuals

Waiver 31915 (c)

All Eligible Individuals

• Adds a middle waiver

• Provides additional flexibility

• Infuses LifeCourse principles into an enhanced service array

• Provides some opportunity for utilizing self-directed option

Path #2: Three Waiver

Structural Elements

• Case Management

• Case Management is a vital resource & essential to the

success of waiver redesign and systems transformation

• Looking at all systems and structures in place to deliver

Case Management

• DDRS to convene Phase Two of Case Management

Innovation

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Structural Elements

• Self-Direction

• Clear indication from stakeholders about the desire for self-

directed service option

• Developing the infrastructure necessary to support a full

self-directed program takes time

• Concept paper presents opportunities for self-direction that

could be added now

• Adding a service Participant-Directed Goods & Services

• Adding Agency with Choice

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Possible Services Changes: Approach

• Clarify Service Names

• Group and Simplify Services

• Change or Remove Services

• Add New Services

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Current New

Extended Service Supported Employment

Prevocational Services Learning and Work Experience

Current New

Residential Habilitation & Support

Residential Habilitation & Support- Daily

Residential Habilitation &

Support

Current New

Family and Caregiver Training Family/Caregiver Supports

Add New Services

• Career Exploration

• Housing Support Services

• Healthy Living Services

• Expressive Therapy Services

• Peer Support and Community Connection

• Participant Directed Goods and Services

• Assistive Technology, Assessment, and Training

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Underpinnings of the Approach

• Project Team Approach

• LifeCourse Principles

• Stakeholder Engagement

• Environmental Scan

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The Path Forward

• Obtaining feedback from various stakeholders is key

• Opportunities to provide feedback on initial concept paper will be

available now through April 2020

• Additional opportunities for feedback will also be available once the

ideas and options proposed have been further developed

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Milestone Dates

Initial Concept Paper Released January 2020

Public Input Period on Initial Concept Paper January 2020 – April 2020

Concept Paper Expanded April 2020 – June 2020

Final Concept Paper Released June 2020

Public Input Period on Final Concept Paper June 2020 – July 2020

Opportunities for Engagement

• Electronic Survey (https://iu.co1.qualtrics.com/jfe/form/SV_6qXBDMKLzCxZDY9)

• Self-Advocate Sessions Hosted by IIDC and SAI

• Meeting in a Box for Advocacy Organizations

• Innovation Workgroups on: Waiver Structure, Case Management, and Service Array

• DDRS Advisory Council Deep-Dive Discussions

• Usual Channels – E-mail, Bulletin, Social Media

• Every Other Week Facebook Live Events

• DDRS Stakeholder Webinar

• DDRS Attendance at Organization Meetings17

Timeline

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04/2019 05/2019 06/2019 07/2019 08/2019 09/2019 10/2019 11/2019 12/2019 01/2020 02/2020 03/2020

Task 1 –Convene Kick-Off

Task 2 – Research: Indiana Context

Task 3 – Research: Innovation

Task 4 – Findings/Outline Approach Stakeholder Feedback

Initial HSRI & Milliman Meeting – Regular Meetings Scheduled on On-Going Basis

FSW / CIHW Renewal Development and Public Comment

FSW / CIHW Renewal Submission to CMS and Review Period

04/2020 05/2020 06/2020 07/2020 08/2020 09/2020 10/2020 11/2020 12/2020 01/2021 02/2021 03/2021

Task 5 – Final Concept Paper Task 6 – Waiver Development

Milliman Rate Methodology Development

Stakeholder Feedback

Task 7 – Waiver Finalization

Stakeholder Feedback and Public Comment

Concurrent Rate Methodology Public Comment

Concurrent CMS Review Period

Task 6

Rate

04/2021 05/2021 06/2021 07/2021 08/2021 09/2021 10/2021 11/2021 12/2021 01/2022 02/2022 03/2022

Renewals Begin

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