Department of Mental Department of Mental Health, Retardation and Health, Retardation and

Hospitals (MHRH)Hospitals (MHRH)

Services for individuals with Services for individuals with Developmental DisabilitiesDevelopmental Disabilities

Individuals with Developmental Individuals with Developmental DisabilitiesDisabilities

The total number of individuals The total number of individuals receiving services in the communityreceiving services in the community--based private system is 3321. based private system is 3321. Including RICLAS it is 3570. Including RICLAS it is 3570.

Only 1750 are receiving 24 hour Only 1750 are receiving 24 hour residential supports including residential supports including SLA’sSLA’sand RICLAS (248).and RICLAS (248).

Private Community DD by Funding Source

69,440,324

2,963,26120,590,806

91,744,770 1,352,744

StateFed CNOMFed MedicaidFed StimulusFed Other Grants

FY 10 Working Total $186.1 M

Who is Eligible?Who is Eligible?To be eligible for supports funded through MHRH,individuals To be eligible for supports funded through MHRH,individuals must meet the definition of developmental disability, as stated must meet the definition of developmental disability, as stated In R1 State Law: In R1 State Law:

“The term 'developmental disability’ means a “The term 'developmental disability’ means a severe. severe. chronic chronic disability of a person which: disability of a person which: Is attributed to a mental or physical impairment or combination Is attributed to a mental or physical impairment or combination of of mental and physical impairments; mental and physical impairments; Is manifested before the person attains age twentyIs manifested before the person attains age twenty--two two (22)(22); ; Is likely to continue indefinitely; Is likely to continue indefinitely; results in substantial functional limitations in three or more oresults in substantial functional limitations in three or more of f the following areas of major life activity: the following areas of major life activity: •• personal care personal care •• communication communication •• mobility mobility •• learning learning •• selfself--direction direction •• capacity for independent living capacity for independent living •• economic selfeconomic self--sufficiency, and, sufficiency, and,

reflects the person’s reflects the person’s need need for a combination and sequence of for a combination and sequence of special, interdisciplinary ,or generic care, treatment, or otherspecial, interdisciplinary ,or generic care, treatment, or otherservices which are lifeservices which are life--long or extended duration and are long or extended duration and are individually planned and coordinated."individually planned and coordinated."

DEFINITIONS OF THE CRITERIA FOR DEFINITIONS OF THE CRITERIA FOR DETERMINATION OF ELIGIBILITY FOR DDD DETERMINATION OF ELIGIBILITY FOR DDD

SERVICESERVICESS

““Substantial functional limitationSubstantial functional limitation” ” means the applicant performs means the applicant performs substantially below the level substantially below the level expected for an adult with respect to expected for an adult with respect to the skills necessary in an area of the skills necessary in an area of major life activity.major life activity.

““Self care”Self care”, means the daily activities that , means the daily activities that enable a person to meet basic life needs for enable a person to meet basic life needs for

food, hygiene and appearance.food, hygiene and appearance.

““Substantial functional limitation in Substantial functional limitation in selfself--carecare” means that an individual ” means that an individual needs onneeds on--going physical assistance, going physical assistance, extensive training and/or frequent extensive training and/or frequent supervision in taking care of personal supervision in taking care of personal needs such as eating, personal needs such as eating, personal hygiene and dressing.hygiene and dressing.

““Receptive and expressive languageReceptive and expressive language” means ” means communication involving both verbal and noncommunication involving both verbal and non--verbal behavior enabling the individual both to verbal behavior enabling the individual both to

understand others and to express ideas and understand others and to express ideas and information to others.information to others.

““Substantial functional limitation in Substantial functional limitation in expressive and receptive languageexpressive and receptive language means means that an individual needs another person or that an individual needs another person or alternative method to express or alternative method to express or understand needs and wants or to understand needs and wants or to effectively communicate with others or the effectively communicate with others or the Individual is unable to Individual is unable to understand/comprehend language or understand/comprehend language or other forms of communication.other forms of communication.

““MobilityMobility means motor development and the means motor development and the ability to use fine and gross motor skills; the ability to use fine and gross motor skills; the

ability to move from one place to another.ability to move from one place to another.

““Substantial functional limitation in Substantial functional limitation in mobilitymobility” means that an individual ” means that an individual needs the ongoing physical needs the ongoing physical assistance of another person to assistance of another person to move from place to place or needs move from place to place or needs the use of an extraordinary assistive the use of an extraordinary assistive device to move from place to place.device to move from place to place.

Step 2.Step 2.Step Two involves the completion of a Step Two involves the completion of a personal Capacities Inventory (PCI) and personal Capacities Inventory (PCI) and Situational Assessment. This will help Situational Assessment. This will help determine the amount of funding that determine the amount of funding that DDD can make available for your servicesDDD can make available for your servicesA social worker will help you apply to the A social worker will help you apply to the Department of Human Services for Department of Human Services for Medicaid and Title XIX Waiver eligibility if Medicaid and Title XIX Waiver eligibility if necessary. necessary.

DD SERVICE CATEGORIESDD SERVICE CATEGORIESRESIDENTIAL SUPPORTS:RESIDENTIAL SUPPORTS:

Residential supports include community residences Residential supports include community residences and other twentyand other twenty--four hour supports, Shared living, four hour supports, Shared living, semisemi--supervised apartment programs and other more supervised apartment programs and other more part time support arrangements as well as a variety of part time support arrangements as well as a variety of supported living arrangements. supported living arrangements.

Residential supports, in general, are supports offered Residential supports, in general, are supports offered to persons who live apart from family members and to persons who live apart from family members and who have insufficient natural supports to maintain who have insufficient natural supports to maintain independent living situations. The intensity of the independent living situations. The intensity of the support varies from person to person. Funding within support varies from person to person. Funding within the Residential Support category will only be made the Residential Support category will only be made available to persons who have been determined to available to persons who have been determined to have “Clinical Necessity” or who are at risk due to have “Clinical Necessity” or who are at risk due to situational factors.situational factors.

DDD SERVICE CATEGORIESDAY ACTIVITY/ EMPLOYMENT SUPPORTS:

In general Day Activity / Employment supports are regularly occurring activities that provide a sense of community participation, personal accomplishment, reward, or remuneration and thereby serve as therapeutic vehicles to maintain or increase adaptive capabilities, independence, and integration into the community. Supports can vary to a great extent and include sheltered workshops, supported employment, volunteer experiences, recreation and other community linkage efforts.

Supports available through these programs typically take place more or less during normal working hours. However increasingly these supports have been provided at other times of the day as well.

DDD SERVICE CATEGORIESFAMILY SUPPORTS:

Family support services that are intended to assist individuals to continue to live with their families. These family supports include but are not limited to personal care, homemaking, community access, skill development, transportation, respite, assistive technology and home modification.

In general, supports within this category are intended to augment the person's and/or family's existing support system. An understanding of the discrepancy between the person's and/or family's need for support and the availability of existing support is critical to the determination of need for this category of support. Funding within the Family Support category will only be made available to persons/families who have been determined to have “Clinical Necessity” or who are at risk due to situational factors.

RESIDENTIAL 24 HR LEVELSRESIDENTIAL 24 HR LEVELSLEVEL 1 / 24 Hour:LEVEL 1 / 24 Hour: Services expected include periodic direct support Services expected include periodic direct support and monitoring, reminders, and supervision. Staff is available and monitoring, reminders, and supervision. Staff is available for for supervising the individual in personal care, work around the housupervising the individual in personal care, work around the house, and se, and accessing the community. Staff are not expected to have 24 houraccessing the community. Staff are not expected to have 24 hour direct direct contact with the individual. contact with the individual. LEVEL 2 / 24 Hour:LEVEL 2 / 24 Hour: Services expected include ongoing direct support for Services expected include ongoing direct support for most of the day. More intense supports are required in the mornmost of the day. More intense supports are required in the morning and ing and evening. Some direct support and supervision of the individual evening. Some direct support and supervision of the individual in in personal care, work around the house, and accessing the communitpersonal care, work around the house, and accessing the community is y is expected. Staff must be available to the individual with short expected. Staff must be available to the individual with short absences 24 absences 24 hours a day. This level includes periodic professional support hours a day. This level includes periodic professional support and and assessment for physical, behavioral or medical conditions. It isassessment for physical, behavioral or medical conditions. It is not not intended that staff be constantly available on a one to one basiintended that staff be constantly available on a one to one basis. s. LEVEL 3 / 24 Hour:LEVEL 3 / 24 Hour: Significant direct support is expected most of the Significant direct support is expected most of the day. Direct support includes substantial physical assistance widay. Direct support includes substantial physical assistance with personal th personal care or mobility. Staff, in most cases, must perform household care or mobility. Staff, in most cases, must perform household tasks. tasks. Support staff are also expected to provide support for physical,Support staff are also expected to provide support for physical, behavioral behavioral and medical conditions. Oneand medical conditions. One--toto--one staff support may be required to one staff support may be required to access the community. The full range of professional supports aaccess the community. The full range of professional supports are re expected routinely. expected routinely. LEVEL 4 / 24 Hour:LEVEL 4 / 24 Hour: Intensive direct support is expected 24 hours a day. Intensive direct support is expected 24 hours a day. Most personal care and community integration activities require Most personal care and community integration activities require oneone--toto--one staffing. Staff are expected to address physical, behavioraone staffing. Staff are expected to address physical, behavioral and l and medical conditions. Staffing ratios are higher for some activitmedical conditions. Staffing ratios are higher for some activities including ies including the expectation that backthe expectation that back--up is available for community integration up is available for community integration activities. The full array of professional services must be avaactivities. The full array of professional services must be available and ilable and may be required to provide intensive levels of support. may be required to provide intensive levels of support.

RESIDENTIAL NON 24 HOURRESIDENTIAL NON 24 HOURLevel 1 Non/24 Hour: Level 1 Non/24 Hour: Support is necessary several days per week to assist Support is necessary several days per week to assist an individual to maintain apartment or other independent living an individual to maintain apartment or other independent living situation. situation. Person is able to be without support for at least a day at a timPerson is able to be without support for at least a day at a time and as much e and as much as several days at a time. The Division’s expectation is that anas several days at a time. The Division’s expectation is that an individual individual funded at this level would receive two to four hours of support funded at this level would receive two to four hours of support several times several times per week. An individual could expect to receive significantly moper week. An individual could expect to receive significantly more support if re support if able and willing to share support with housemates. able and willing to share support with housemates. Level 2 Non/24 Hour: Level 2 Non/24 Hour: Support is necessary several hours each days of the Support is necessary several hours each days of the week to assist an individual to maintain apartment or other indeweek to assist an individual to maintain apartment or other independent pendent living situation. Person is able to be without support for multiliving situation. Person is able to be without support for multiple hours during ple hours during the day and does not require an onthe day and does not require an on--site overnight presence. The Division’s site overnight presence. The Division’s expectation is that an individual funded at this level would recexpectation is that an individual funded at this level would receive several eive several hours of support each day. hours of support each day. Level 3 Non/24 Hour: Level 3 Non/24 Hour: Support is necessary during different segments of Support is necessary during different segments of each day to assist an individual to maintain apartment or other each day to assist an individual to maintain apartment or other independent independent living situation. Person is able to be without support for severliving situation. Person is able to be without support for several hours at a al hours at a time and does not require an ontime and does not require an on--site overnight presence. The Division’s site overnight presence. The Division’s expectation is that an individual funded at this level would recexpectation is that an individual funded at this level would receive some eive some support during the morning and several additional hours of supposupport during the morning and several additional hours of support each rt each afternoon or evening. afternoon or evening. Level 4 Non/24 Hour: Level 4 Non/24 Hour: Support is necessary during most hours of each day Support is necessary during most hours of each day to assist an individual to maintain apartment or other independeto assist an individual to maintain apartment or other independent living nt living situation. Person is able to be without support for brief periodsituation. Person is able to be without support for brief periods of time during s of time during awake hours but does not require an onawake hours but does not require an on--site overnight presence. The site overnight presence. The Division’s expectation is that an individual funded at this leveDivision’s expectation is that an individual funded at this level would receive l would receive support during most of their awake hours but could be able to hasupport during most of their awake hours but could be able to have only on ve only on call overnight support. call overnight support.

DAY / EMPLOYMENT LEVELSDAY / EMPLOYMENT LEVELSLEVEL 1LEVEL 1: Periodic ongoing direct support and intermittent : Periodic ongoing direct support and intermittent supervision for completion of routine tasks, learning new skillssupervision for completion of routine tasks, learning new skills, , and skill maintenance. and skill maintenance. LEVEL 2:LEVEL 2: Ongoing regular support for completion of routine tasks Ongoing regular support for completion of routine tasks including indirect support or a moderate amount of direct supporincluding indirect support or a moderate amount of direct support. t. Supports include verbal reminders, organization or environmentalSupports include verbal reminders, organization or environmentalcues, structured activities, assistance in decisioncues, structured activities, assistance in decision--making, and making, and assistance in avoiding risky situations. This level also includassistance in avoiding risky situations. This level also includes es ongoing, regular support to teach new skills as well as ongoing ongoing, regular support to teach new skills as well as ongoing support for skill maintenance. This level includes assessment asupport for skill maintenance. This level includes assessment and nd periodic professional services.periodic professional services.LEVEL 3:LEVEL 3: Significant direct supports for completion of routine Significant direct supports for completion of routine activities including close supervision and/or physical assistanactivities including close supervision and/or physical assistance ce for completion of tasks, as well as direct support with for completion of tasks, as well as direct support with communication or mobility. Onecommunication or mobility. One--toto--one support during a portion one support during a portion of the day and close proximity throughout the day. Level 3 alsoof the day and close proximity throughout the day. Level 3 alsoincludes the full range of professional support services to meetincludes the full range of professional support services to meetthe regular needs of individuals for professional support. the regular needs of individuals for professional support. LEVEL 4:LEVEL 4:Continuous supports are provided including frequent and Continuous supports are provided including frequent and intensive handsintensive hands--on support for routine tasks and continuous on support for routine tasks and continuous intensive standintensive stand--by support. Oneby support. One--toto--one support and greater than one support and greater than oneone--toto--one support at times during the course of the day. Level 4 one support at times during the course of the day. Level 4 also includes the full range of intensive professional service also includes the full range of intensive professional service supports as required by the individual. supports as required by the individual.

NOTE: Supported employment can be provided in any of the levels NOTE: Supported employment can be provided in any of the levels listed listed above.above.

FAMILY SUPPORTFAMILY SUPPORTRESPITE LEVEL: RESPITE LEVEL: The Division’s expectation is that the individual The Division’s expectation is that the individual and family would receive up to 180 hours of respite services perand family would receive up to 180 hours of respite services peryear. Accommodations in the number of individual hours can be year. Accommodations in the number of individual hours can be made to receive overnight or weekly respite support. Typically imade to receive overnight or weekly respite support. Typically if a f a family requests only overnight respite, they could expect to family requests only overnight respite, they could expect to receive approximately 12 overnights of respite per year if the receive approximately 12 overnights of respite per year if the overnight rate was applied instead of the hourly rate.overnight rate was applied instead of the hourly rate.LEVEL 1: LEVEL 1: The Division’s expectation is that an individual funded The Division’s expectation is that an individual funded at this level would receive between 4 and 6 hours per week of at this level would receive between 4 and 6 hours per week of individual staff support and could expect to receive significantindividual staff support and could expect to receive significantly ly more support if able and willing to share support with other more support if able and willing to share support with other individuals who receive funding for support. individuals who receive funding for support. LEVEL 2: LEVEL 2: The Division’s expectation is that an individual funded The Division’s expectation is that an individual funded at this level would receive between 10 and 12 hours per week of at this level would receive between 10 and 12 hours per week of individual staff support and could expect to receive significantindividual staff support and could expect to receive significantly ly more support if able and willing to share support with other more support if able and willing to share support with other individuals who receive funding for support. individuals who receive funding for support. LEVEL 3: LEVEL 3: The Division’s expectation is that an individual funded The Division’s expectation is that an individual funded at this level would receive between 18 and 20 hours per week of at this level would receive between 18 and 20 hours per week of individual staff support and could expect to receive significantindividual staff support and could expect to receive significantly ly more support if able and willing to share support with other more support if able and willing to share support with other individuals who receive funding for support.individuals who receive funding for support.LEVEL 4: LEVEL 4: The Division’s expectation is that an individual funded The Division’s expectation is that an individual funded at this level would receive between 30 and 35 hours per week of at this level would receive between 30 and 35 hours per week of individual staff support and could expect to receive significantindividual staff support and could expect to receive significantly ly more support if able and willing to share support with other more support if able and willing to share support with other individuals who receive funding for support individuals who receive funding for support

Step 3.Step 3.

You will be notified of the funding You will be notified of the funding level (range) that is available for level (range) that is available for your services.your services.

Step 4.Step 4.Choose your service provider or a Fiscal Choose your service provider or a Fiscal Intermediary to help you manage your Intermediary to help you manage your own plan. This Agreement will give a brief own plan. This Agreement will give a brief description of the services you plan to description of the services you plan to purchase, and how the agency will provide purchase, and how the agency will provide them. It will also list the outcomes that them. It will also list the outcomes that are most important to you. are most important to you.

Once the Support Agreement is approved, Once the Support Agreement is approved, services can begin.services can begin.

Shared Living Arrangements (SLA)Shared Living Arrangements (SLA)People supported by private Agencies presented by funding levels

17

41

24

5

87

0102030405060708090

100

Level 2 Level 3 level 4 no level Peoplesupported

SLA Growth in Past yearSLA Growth in Past year

People supported in private SLA's

4551 52 55 58 63 65 67

73 76 80 80 83 87

0102030405060708090

100

Jun-08 Jul-08 Aug-08

Sep-08

Oct-08 Nov-08

Dec-08

Jan-09 Feb-09

Mar-09 Apr-09 May-09

Jun-09 Jul-09

WhereWhere

People supported by private SLA Agencies (7-31-09) and State

4

15

510

2 2

43

1 1 2 2

53

0

10

20

30

40

50

60

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From WhereFrom Where

Program origins

10 12 7 12 123 5 3 1 7 8

80

0102030405060708090

RIClASPer D

iemFamily

Homeplaced pr

e 2006

DCYF Turned 21fro

m L1 24fro

m L2 24fro

m L3 24fro

m L4 24emergency newnon 24>SLA total

SavingsSavingsSavings comparing Group home placements to SLA 7/31/09 ( This is not actual

savings however it is a comparison of rates )

$631,600.00

$1,636,128.00

$932,615.00$1,154,160.00

$4,354,503.00

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100000015000002000000250000030000003500000400000045000005000000

Savings RICLAS Savings L2 GoupHome

Savings L3 GroupHome

Savings L4 GroupHome

total savings