Thursday, May 19, 2016

Michigan Dental Health

This is an overview of oral health in Michigan, including vulnerable populations, such as seniors, pregnant women, low-income children and other special populations, who are at risk for poor oral health outcomes.

This is part of a presentation from the Dental Access Project of the Michigan Council for Maternal and Child Health.

More information on the Michigan Dental Access Project: 

Full Report

Interviews with stakeholders

Michigan Maternal & Child Health (MCMCH) Website

The Michigan Dental Access Project has been studying legislation that would allow for Mid-level Dental Therapy as a way to alleviate the need for increased access to dental care. Someone with specialized training or a degree, beyond that of a dental hygienist and similar to that of a physician's assistant or nurse practitioner, could then provide some dental services under the supervision of a dentist that are not currently authorized.

Wednesday, May 18, 2016

Michigan updates on implementation of the Home and Community-Based Services rule

Under the federal 2014 Home and Community-Based Services [or Settings] rule, states must submit transition plans to the federal Centers for Medicare and Medicaid Services (CMS) describing how they will implement federal policies on community integration. Part of that process is to determine whether settings using HCBS funding are in compliance with the federal rule. Michigan will use surveys to make this determination.

Home and Community-Based Services are often referred to as Medicaid Waiver services, because they allow the state to waive some Medicaid requirements in order to use funding in non-traditional ways to serve different populations of people with disabilities.

For people with disabilities who live in their own or their family’s home and receive residential supports funded by HCBS, their residences are presumed to be in compliance with the rule and they will not be part of the residential survey. For people not living in their own or their family’s home, the state will survey every provider of HCBS services and the people who receive HCBS services to evaluate whether the setting complies with the rule.

Michigan’s Habilitation Supports Waiver (HSW) is a Medicaid Waiver that provides services to people with developmental disabilities. The state has other Medicaid Waivers for different categories of the disabled population and people using these waivers will also be surveyed. HSW surveys will be conducted by the Developmental Disabilities Institute (DDI) at Wayne State University in Detroit.

The surveys for providers and participants in the HSW are available for review on-line, but the actual surveys will be conducted by the DDI after notifying providers who will then notify HCBS participants of when the survey will take place. DDI will cover 50% of providers and participants before October 1st, 2016 and 50% after October 1st, 2016.

If you are a guardian or family member of a person who receives HCBS and the person will need your assistance in answering survey questions, the best course of action is to tell the providers of services that you want to be informed of when the survey will be conducted and that you want to participate. If you have a family member with cognitive disabilities, it would also be a good idea to review the survey questions. I found that for my sons many of the questions were not aimed at people with such severe disabilities and that certain answers could be misconstrued as indicating that their services do not comply with the federal rule. Exceptions can be made to parts of the rule for health and safety reasons, but these must be included in the person’s Individual Plan of Services (ISP). Keep that in mind for your next Person-Centered Planning meeting.

For more information on the survey process:

Frequently Asked Questions
 

Surveys of providers and HSW beneficiaries with general information from DDI including surveys in Word document format

Participant surveys

Residential provider Survey

Non-residential provider survey Non-residential services include HCBS-funded programs such as employment, skill-building, prevocational, and day programs. 


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Michigan’s revised State Transition Plan for HCBS

Michigan revised its State Transition Plan for HCBS for public comment in December 2015. The state then revised the plan further and responded to comments. The Revised STP was sent to CMS on March 15, 2016 for approval.

The first part of this document includes comments on the plan with responses from the Michigan Department of Health and Human Services. The rest of the document is the latest revision to the STP.

Here is more Information on the federal HCBS Rule and State Transition Plans.

This is the Michigan Website on HCBS Transition.

Sunday, May 15, 2016

Is the Federal Home and Community-Based Settings Rule just one more excuse not to fund needed DD services?

Jill Escher has written an insightful opinion piece about the 2014 Home and Community-Based Services (HCBS) rule. The rule restricts funding for people with disabilities to settings that meet the federal criteria for community integration. While the HCBS rule purports to protect the rights of people with disabilities to inclusive community living, Escher says that its primary goal is “to put the brakes on the creation of new residences and programs that cater specifically to adults with autism and other intellectual and developmental disabilities.” 

“The Federal Government’s Quiet War Against Adults with Autism”, from the San Francisco Bay Area Autism Society Blog, 4/19/16,  applies not only to adults with autism but to others with intellectual and developmental disabilities. Many of these adults need intensive supports, up to and including 24/7 care and supervision. Congregate care, providing services to people with disabilities in group settings, is one of many practical solutions to the need for long term care. It allows for the sharing of resources and lessening of feelings of isolation. It should not be ruled out as an option, although that appears to be the intent of many advocacy organizations. 


In my opinion, there is also a quiet war on families who are offered no other alternative but to keep their adult child with DD at home with services that may not be adequate to provide the family with the relief they need and a good quality of life for their disabled family member for the long term.

According to the article:


“As our society grapples with the dramatic surge of young adults disabled by autism aging out of school and into the vastly less supported real world, one would think every effort was being undertaken to expand programs and housing to address their serious and lifelong support needs.

“But as it turns out, precisely the opposite appears to be happening. And it stems from a quite intentional new federal policy. Even though the number-one concern of autism families is the availability of long-term care for their disabled adult children, few people seem to know about seismic shifts in the federal approach to funding that are poised to sharply restrict options.”


With HCBS expenditures skyrocketing,

“Former CMS staffer Nancy Thaler, one of the architects of the new regulations, has explained the strategy quite bluntly (see this presentation for example...) saying that to achieve financial sustainability in this era of ‘demographic global warming,’ [referring to the ever increasing medical and care needs of the baby boomer generation] she envisions a system emphasizing supports for the families, and creating a system of adult foster care exempt from the typical and costly employment and tax laws, instead of out-of-home placements such as group homes or disability-supportive communities. Close relationships, she observes, are cheaper than 24-hour paid supports, and will ‘nudge the system toward sustainability.’”

The rule has been extended by further guidance from the Centers for Medicare and Medicaid Services (CMS) on settings that are presumed to possess “institutional qualities”, 


“…wherein CMS retains what appears to be unbridled discretion to deny services funding. Also, in an unusual scorched-earth tactic to contain expenditures, the rules empower community snitches (in reality, those appear to be primarily federally funded advocacy groups) to inform CMS of programs or housing around the country they consider too congregate or disability-specific in nature.”

Disability Discrimination embedded in Law:

“One of the most troubling aspects of the new CMS rules [is] its necessary tool of overt disability discrimination. In an unprecedented move, the government is defining where a minority (here, people with developmental disabilities) can live before they can get needed social services, and promoting the idea of maximum quotas of units available to people with developmental disabilities, even in private residences. How would a senior citizen feel if told he could not receive public assistance if the government felt he lived with too many other elderly people? Should we shut off low-income housing vouchers to African Americans if more than 25% of a property is rented to people of color? Are people with Alzheimer's being told they cannot live with ‘too many’ other people with the condition? On top of the bureaucratic shenanigans, we are also talking about rank discrimination.”

 
Some reason for hope:

“There is some good news here: states retain a good amount of latitude in how they will implement the new regs. Some states will be more accepting of congregate solutions than others. It's my hope, and the hope of countless other autism families and advocates, that California allow the broadest possible range of choices for its autistic and developmentally disabled residents. … I encourage autism families to become familiar with the issues and to fight not only for their children's right to choose, but for an overall system guided by both efficiency and realism. “

Read the entire article here, and pass it on.

More information from the SFAutism Website:

May 20, 2016: Forum on HCBS in California (livestreamed)

 
Autism Society San Francisco Bay Area (SFASA) will be sponsoring a Forum on HCBS Rules in California. This event will feature officials and service providers speaking about the current status of federal funding for adults with autism in our state, and to maximize public access, it will be livestreamed for free (seating at the event is limited). The main purpose is to provide clarity about the rules as they apply in California so that families, programs and nonprofits serving the developmentally disabled can take steps to expand autism-friendly community-based offerings without undue fear of running afoul of federal guidelines when they go into effect in a few years.


Details about the event will be posted in April at the SFASA homepage
 

HCBS in California: Myths v Facts

The Coalition for Community Choice

The Atlantic: Who Decides Where Adults with Autism Live?


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 Website for information on HCBS policies and state transition plans

Friday, May 13, 2016

Village Elementary in Hartland, Michigan: A caring and inclusive community



Every year for 13 years, Vanessa the duck has been laying her eggs in the courtyard at Village Elementary School in Hartland, Michigan, and every year the school helps Vanessa and her ducklings reach their pond and permanent home.

School Clears Out Its Halls Each Year To Help Duck Family Get Home

Vanessa the duck has been laying her eggs in the school’s enclosed courtyard for 13 years.

Thirteen years ago, Vanessa the duck had a little problem.

Her ducklings had hatched in the courtyard of Village Elementary School in Hartland, Michigan, but there was a big ol’ school building in between her nest and the pond where she needed to bring her new family. Fortunately for her, students and staff, led by teacher Ruth Darrah, had a plan, Good Morning America reports.

Darrah made a path through the school’s hallways, ensuring people were out of the way so Vanessa could safely lead the ducklings to the water.

That first year, Vanessa was a little confused about exactly what route to take through the school, but now she breezes through in just a few minutes as soon as someone opens the door for her.

“She has it down by now, after 13 years,” Darrah told Livingston Daily.
...

“It’s the best thing you will ever witness,” Principal William Cain told Livingston Daily.

Michigan DD Council seeks public comment on 2017-2021 Five-Year Plan

from the Michigan DD Council: 
 
The Michigan Developmental Disabilities Council (MDDC) has drafted its 2017-2021 State Plan.

Goals and objectives are identified to improve the availability and quality of services and supports, to assure equal rights and opportunities, and to further community integration and inclusion for individuals with developmental disabilities and their families.  The State Plan provides the basic framework for how Council funds will be used and what activities the Council will be involved in.

We appreciate your time in providing comments and feedback. Please send any comments or thoughts you might have.  There are three (3 ) ways to provide feedback.

Email to:         MDHHS-DD-Council@michigan.gov

US Mail to:      Michigan Developmental Disabilities Council
                        5-year Plan Public Comment
                        c/o Tedra Jackson
                        320 S. Walnut
                        Lansing, MI 48913

Or via Survey Monkey by clicking here .

Additionally, there will be two days where the public can review the plan in-person at the DD Council Office. Friday, May 27th from 8:30am to 5:00pm and Wednesday, June 15th from 8:30am to 5:00pm. The DD Council office is located in the Lewis Cass Building, 320 S. Walnut, Lansing, MI 48913.

We will receive feedback until 12:00 PM Monday, June 27, 2016.

Thank you for your help as we plan for the Councils activities over the next five years. If you have any questions or need assistance please contact the Council office at 517-335-3158.

Link to DD Council 2017-2021 Five-Year Plan5 year


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For more information on the Michigan DD Council, see the 2015 Annual Report

Friday, May 6, 2016

Michigan: Update on Home and Community-Based Services Transition Project

This is from Phil Kurdunowicz at the Michigan HCBS Program Transition Project. Every state has a transition plan to implement the 2014 Home and Community-Based Services rule from the Centers for Medicare and Medicaid Services (CMS). This update concerns surveys that will assess individual settings for "HCBS chacteristics". For people with DD covered by the Habilitation Supports Waiver, surveys of all HCBS-funded programs will begin this month, May 2016. People with DD living in their own or their family's home will be assumed to be compliant with the HCBS rule and will not be part of the survey unless they also attend a program funded by the HSW waiver. 

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Dear stakeholders,

The Michigan Department of Health and Human Services provides Home and Community-Based Services to individuals in the Medicaid program. These services help Michigan citizens with disabilities or other health issues to live at home or in the community. The Department offers many of these services through “waivers,” which were approved by the Centers for Medicare and Medicaid Services.

The Centers for Medicare and Medicaid Services released a new rule in 2014 for home and community-based services waivers. The Department has since developed a statewide transition plan to bring its waiver programs into compliance with the new rule.

As part of the transition process, the Department must determine whether settings under these waivers have “home and community-based” characteristics. For this purpose, the Department has developing a set of “survey tools” to assess individual settings for home and community-based characteristics.

The Department has published the final versions of the survey tools for the Habilitation Supports Waiver to the project website. Survey tools that have been finalized by the Department can be found on the Department’s website at www.michigan.gov/mdhhs >> Health Care Coverage >> Home and Community-Based Services Program Transition.

The Department will start the statewide assessment process for the Habilitation Supports Waiver [for people with DD] in May 2016. The Department will work with the Developmental Disabilities Institute of Wayne State University to conduct these surveys.

If you would like to learn more about the survey process, please visit the following website: http://ddi.wayne.edu/hcbs.php

If you have questions about the survey process, please send an email to hcbs@wayne.edu.

If you have questions about the Home and Community-Based Services rule or the Statewide Transition Plan, please send an email to HCBSTransition@michigan.gov.

Thank you for your continued support for Michigan’s home and community-based waiver programs.

Best regards,

The HCBS Program Transition Team

 
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Frequently Asked Questions regarding the survey process

Friday, April 29, 2016

Illinois Independent Living Centers rally to oppose choice

According to an article in the Illinois Herald-News by Lauren Leone-Cross, 4/4/16, leaders from two Illinois Centers for Independent Living rallied opposition to House Bill 6304 in the Illinois House of Representatives. 

The bill would allow for “an alternative model” of licensing for “continuum of care” centers for people with developmental disabilities. It is supported by Misericordia, a long-established non-profit continuum of care community in Chicago.

According to the article:
 

Sister Rosemary Connelly, the nonprofit's longtime director, said this alternative care method provides a choice for families of those with severe developmental disabilities. "Community-integrated living arrangements are not for everyone, yet it's perceived as the ‘right and only way,’” Connelly said…“[Opponents] are really denying families the right to choice,” she added.

The Centers for Independent Living along with leaders from the Illinois ARC claim that the bill perpetuates “an antiquated system of service delivery and reinforces Illinois’ historic institutional bias."

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As passionate as the opposition is about preventing communities like Misericordia from continuing to receive public funds, it was no match for Sister Rosemary. The bill passed through the House committee and has won approval by the Illinois House of Representatives.

If you visit the Misericordia campus, you will see that it is neither antiquated nor isolated. Misericordia, including its campus and community residences and businesses, has changed over the years to meet the changing needs of the disability community. When I was there in October 2015, they had just opened an Alzheimer’s nursing facility for people with disabilities as well as maintaining a variety of living and recreational facilities. It is located in a north side Chicago neighborhood with access to all the amenities of city life along with specialized services for people with the most severe disabilities.

The 2014 Home and Community-based Services (HCBS) rule is being exploited by federal and some state agencies and federally-funded advocates to limit choice and shift more responsibility onto over-stressed families and communities unprepared to serve people with severe disabilities. Misericordia’s programs and services may be in  jeopardy if this continues. 

And isn’t this ironic? Centers for Independent Living are required to have a majority of their staff and board members be people with disabilities, but their leadership opposes all congregate settings that group more than 3 or 4 people together when they have intellectual and developmental disabilities. Here’s an interesting question: If a person with ID/DD wants to work  at a CIL, could HCBS funding to assist the individual be denied because of the institutional quality of the CIL with so many people with disabilities in one place?

More on Misericordia...