Direct Support Professional Credential

Design

NYSACRA 12th Annual Leadership ConferenceSaratoga Springs, NY

12.4.14

CONTEXT AND BACKGROUND OF DSP WORK

The state in which people with IDD live is the biggest predictor of outcome, the organization and factors such as turnover and culture are next

Residence Size & Type -- June 30, 2012New York United States

Changes in the number of people with IDD living in individualized

settings 2000 to 2012

New York United States

Estimated number of Medicaid LTSS recipients with IDD by funding authority

2006-2012

New York United States

DSP WORKFORCE/PROFESSION

Quality IS about and IS achieved through competent and reliable DSPs

Competent direct support workforce

DSP expectations

Person-centeredCulturally competent

Support Choice

Maintain health & safety

Comply with rules and regs.

End shift neat & tidy

Work well with others

Document

Teach

Problem-solve

Respect rights

Medical Support

Specialized knowledge

State of Direct Support

No IDD specific data

Note: 23% are foreign born

Sustained DSP workforce challenges (30 years)

• High Turnover / Low wages• Poor access to and utilization of benefits• Limited access to training and education• Increasingly absent or ineffective supervision• Status and Image

Sustaining “As Is” is costly• Quality• $$$$

25+ years, things are improving…

Positive Change Occupational Title = DSP Credentialing options exist Excellent tools available

Growing evidence base Status and Image

Recognition Codified core competencies

DSPs + FLSs Policy

CMS letter to states/toolkit CMS minimal data set

DSP competencies

Community Support Skill Standards NADSP Competencies DOL LTSS Core Competencies NY OPWDD Core Competencies CMS Core Competencies

CSSS 1996

Hewitt1998

NADSPEst 2002

DOL LTSS2012

CMS DSW2014

2013 NY OPWDD

BUT.. These challenges remainRemaining Challenges Challenging demographic changes Wages are worse when adjusted for

inflation Turnover remains challenging Vacancies and growth stagnation

continue Little to no real penetration of post

secondary Pervasive lack of IDD data

NY Direct Support Professional (DSP) Credentialing Study

Conducted by Research and Training Center on Community Living at UMN

In partnership with NYSACRA and NYSRA Funded by OPWDD

At the conclusion of the 2014 New York legislative

assembly a commitment was made to better

understand the programmatic and financial

implications of implementing a pilot of a robust

credentialing program in the state of New York.

Legislative language

No later than January 1, 2016 (which really means July/August 2015) OPWDD shall issue a report to the Governor, the temporary president of the Senate and the Speaker of the Assembly setting forth recommendations for the establishment of a direct support professional credentialing pilot program. Recommendations for the program shall be based on a study to be conducted by the Office for people with developmental Disabilities and shall include consideration of:

Continued…

1.National and international models of direct support credentialing,2.Career ladders for direct support professionals and supervisors3.Current direct support professional salaries and training requirements, 4.Classroom and on-the-job training requirements for existing direct support credentialing programs and the impact of these requirements on operations of providers of service, 5.On-going and continuing education requirements for credentialed direct support professionals,6.Fiscal impact of a credentialing pilot program7.Financial incentives for those that complete the credentialing program” (AB 9205).

Key credentialing project activities

1. Review and environmental scan Contemporary human service credentialing and

apprenticeship models

2. Facilitate stakeholder engagement Advisory committee

3. Regional focus groups DSP, employers, families, self-advocates

4. Financial model that builds training into Medicaid reimbursement

5. Communication Plan 6. DSP training and credentialing provider

survey

LITERATURE REVIEW AND ENVIRONMENTAL SCAN (UMN - 2/28)

Conduct a Literature Review and Environmental Scan of Contemporary Credentialing and Apprenticeship Models in Human Service Sectors

DSP career paths

Ladder Lattice

STAKEHOLDER ENGAGEMENT - (NYSACRA - THROUGHOUT)

Facilitate a Stakeholder Engagement Process to Guide Credentialing Feasibility and Recommended Implementation Process (Advisory Committee)

Advisory Committee Roles Review and approve provider DSP survey Identify constraints and opportunities in NY with

regard to various credentialing models review and evaluate pros/cons of existing

credentialing models Review, discuss and identify implications of focus

group findings Discuss and recommend credentialing model and

CMS framework Develop implementation and sustainability

strategies in collaboration with stakeholders that promote regional buy-in

Focus groups – (UMN- 4/30)

Conduct Regional Focus Groups with DSPs and Employers Regarding NY DSP Credentialing program Implementation

Regional focus groups

Participants DSPs, FLS, Executive Director, Family, Self-

Advocate Inclusive of public and private sectors Questions

Potential Benefits of Credential Program for Service Recipients & Families DSPs Employers

How to support DSPs? Barriers? Structure of Educational/Training Program Realistic, Accessible & Person-Centered

Financial Model – (UMN - 5/30)

Create a Financial Model that Builds the Training Costs Into Medicaid Reimbursement Rates

Inclusion of Training Costs in Rate Setting--July 13, 2011 CMS Bulletin

Costs associated with requirements that are prerequisite to being a qualified Medicaid provider are not reimbursable by Medicaid.

Costs associated with maintaining status as a qualified provider may be included in determining the rate for services.

A State may require a provider to acquire continuing education (CE) each period and may recognize such CE expenses as a cost to the provider of doing business and may consider such costs in developing the rate paid for the service.

July 13, 2011 CMS Bulletin: Inclusion of Training Costs in Rate Development

A State may wish to promote advanced provider skills training to increase the availability of providers qualified to serve beneficiaries with more complicated or difficult medical needs.

These costs could also be included in the development of rates paid for services requiring more complex levels of care.

A State could set provider qualification requirements at a separate and distinct level for those advanced level providers, and pay rates commensurate with their higher skill levels. The qualifications and rates could be higher than those for services furnished by less skilled individuals.

Building Training Costs into Medicaid Reimbursement Rates

33

Coverage of Direct Service Workforce Continuing Education and Training within Medicaid Policy and Rate Setting:

A Toolkit for State Medicaid Agencies

Submitted by: National Direct Service Workforce Resource Center

http://www.dswresourcecenter.org/tiki-index.php?page=reports

Communication plan – (5/30)

Create a Comprehensive Credentialing Program Implementation Communication Plan and Related Tools

Data and stories

Irrespective of the outcome there will be

Useful ammunition for your advocacy Important next steps identified Model to implement here

And elsewhere

Meet legislative requirement

PROVIDER SURVEY - (UMN - 4/30)

Develop, implement and analyze a DSP Training and Credentialing Provider Survey to Obtain a Baseline of Critical Workforce Indicators

Need for provider survey

Staffing ratios Size, scope and demographics of

workforce Wages and other costs data will

inform credential costs and financial model

Vacancies and turnover also factor into costs and feasibility of credentialing

Regional differences Current practices

Sample Providers who submitted CRF Statewide

Not limited to NYSACRA and NYSRA members

Random sample N= 305 Regional differences 95% confidence interval

Survey distribution plan NYSACRA will send an e-mail alerting

provider one week before launch Within one week Qualtrics (UMN on-line

survey program) will send survey to provider with greeting

NYSACRA will send follow up e-mail to providers to be sure they received survey link and if not to check SPAM

January Q&A session One last follow up before close of survey

*****SPAM*****Inboxx

Scott Spreat <sspreat@gmail.com>Attachments3:03 PM (1 hour ago)

to me Attachments areaPreview attachment wage study data collection 101014.docxWordwage study data collection 101014.docx

Look for this

Who should complete this survey?

Organizational profile

Region Size and scope of organization

Staffing

# of employees DSP FLS Admin/other

Demographics of employees Education PT/FT

Wages

Starting, average, highest DSP and FLS

Benefits Sick Vacation PTO FT/PT status for eligibility Expenditures Insurance

ACA implications Take up/utilization Costs

Org/employee

Retention

DSPs and FLS Challenges Crude separation Vacancies Reasons for turnover Interventions used

Recruitment

DSP/FLS Extent to which a problem Sources Motivations to work for

organization Effective strategies Advertising costs

Staffing practices

OT Use of temporary workers Challenges due to short staffing

Training, career enhancement and credentialing activities

Organizational revenue Training budget DSP career enhancement activities DSP training in org

# hours Adequacy

Credentialing (assumptions are provided)

Incentives Support Predicted participation

Finance, provider costs and public payment policies

% revenue spent on DSP/FLS/admin wage costs

Non reimbursed services Wage increases Increased costs to organization Concerns and recommendations for

rate setting processes

Funding and Disclosure Statement

Preparation of this presentation was supported, in part, by a cooperative agreement from the Administration on Intellectual and Developmental Disabilities, Administration for Children and Families, U.S. Department of Health and Human Services and a grant (#H133B080005) from the National Institute on Disability and Rehabilitation Research (NIDRR). Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore necessarily represent official AIDD or NIDRR policy.

Contact InformationAmy Hewitt, Ph.D. Lori Sedlezky, MSW612.625.1098 612.624.7668hewit005@umn.edu sedl0003@umn.edu

Research and Training Center on Community LivingInstitute on Community Integration (UCEDD) University of Minnesota, Twin Cities214 Pattee Hall, 150 Pillsbury Drive SEMinneapolis, MN 55455

This research was supported by grant from the National Institute on Disabilities and Rehabilitation Research, U.S. Department of Education #H133G080029 and #H133B080005. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore necessarily represent official NIDRR policy.