The Office of Aging & Disability Services Update 4/8/2019

April 8, 2019

Staff Update

Derek Fales is serving as Acting Associate Director of Developmental Services and Brain Injury while the Department reopens the search for a permanent Associate Director. We are in the process of updating the position announcement and plan to post it later this month.

Federal Home and Community Based Services (HCBS) Rule-Provider Guide Now Available

The 2014 federal HCBS rule expands choice and autonomy for people of all ages with disabilities. It will also change the way some providers offer services to ensure HCBS waiver services do not isolate people from the community but rather increase community inclusion and integration. Everyone should be aware that work is underway on Maine's State Transition Plan (STP) to ensure compliance with the rule by 2022. The Centers for Medicare and Medicaid Services (CMS) recently completed its review of Maines draft STP (submitted in June of 2016), and the Department is now updating the plan based on that review. Implementing the plan will require a significant effort at all levels of our system, from policy to service delivery. The Department will be reaching out to stakeholders more about this in the coming months. In the meantime, we encourage providers to begin assessing their own readiness by using a draft guide we have put together to:

-Inform providers of what the HCBS settings rule is;

-Describe how the rule affects the way we support individuals receiving support and services; and

-Provide practical tips and guidance on meeting the requirements of the rule.

Download the HCBS Providers Guide here

Section 21 Amendment Open for Comments Through May 2: Proposes Licensing Per Diem Home Support Locations with 1-2 Members

The State of Maine is planning to amend the Home and Community Based Services waiver, known in Maine as Section 21 of the MaineCare Benefits Manual. One proposed change in the waiver amendment adds a requirement that all service locations providing Per Diem Home Support must be licensed or issued a conditional license by the Maine Department of Health and Human Services, Division of Licensing and Certification, effective July 1, 2020. Licensing will provide increased Department oversight for the Per Diem Home Support locations that are not currently licensed. In addition to the licensing rules for assisted housing, these facilities will be required to comply with the one-family and two-family dwelling chapter of the National Fire Protection Associations Life Safety Code. This change will bring facilities serving one or two members into alignment with the existing licensing requirements for facilities that provide services to three or more members. The licensing regulations can be found here

The Section 21 waiver amendment can be found here. Comments on the waiver amendment can be submitted through May 2, 2019, and they can be provided to the Department in the following ways:

By e-mail to: Policy.DHHS@maine.gov
By mail to: Division of Policy/MaineCare Services 242 State St., 11 State House Station Augusta, Maine 04333-0011

Structured Decision Making

Adult Protective Services is in the process of implementing Structured Decision Making (SDM), which involves a "decision tree" approach to standardize the APS process while recognizing that every case is unique and requires trained staff to support and protect incapacitated and dependent adults. APS will be implementing the Intake and Safety assessments of SDM, which will serve to improve consistency in the Intake phase and ensure that the appropriate response is initiated during the initial face-to-face meeting with clients. APS work groups recently met to assist in developing the assessment tools. Following the development phase, the assessment tools will be tested statewide to ensure consistency across and within all districts. After Maine APS SDM tools are tested and finalized, they will be incorporated into the Evergreen client data system. Implementation is anticipated in January 2020. To learn more about the application of SDM in adult protection, click here

Implementation of Office of the Inspector General (OIG) Recommendations

Substantial work has been completed to strengthen the Reportable Events System (Maines Critical Incident system) for individuals with developmental disabilities, as recommended by the OIG. Upon receiving the OIGs audit report, the Department submitted a plan to the Centers for Medicare and Medicaid Services (CMS) to address each finding. The Department has since provided regular updates to CMS. The Department has now completed all items in its plan, including the following:

-Adopted revised rules related to the Reportable Events System and Adult Protective Services. These revised rules provide clearer definitions of critical incidents and clearer guidance on how to report and follow up on critical incidents;

-Developed an electronic critical incident dashboard to analyze and report data to providers, and ensure that emergency department visits, deaths and other critical incidents are reported and acted upon timely;

-Met with providers quarterly to review dashboard data and identify issues (a process that will continue); and

-Developed a new client data system, Evergreen, which will enhance the Departments capacity to evaluate critical incident data and identify trends and patterns to prevent recurrences. See more on Evergreen below.

Evergreen

Evergreen is the name of the new client data system for OADS programs that will ultimately replace three of our legacy systems: the Enterprise Information System (EIS -- supporting Developmental Services), the Maine Adult Protective Services Information System (MAPSIS) and MeCare (the States long-term care assessment system). The project officially kicked off in July of 2018 and is on track for its first release (the Program Management module) in May 2019, with subsequent releases in 2020 and beyond.

Evergreen will improve OADS ability to implement data-driven business decisions for all program areas, including the administration of the MaineCare Home and Community Based Waiver Services and implementation of audit recommendations from the Office of the Inspector General (OIG). Evergreen will automate some of OADS current manual and paper processes, add functionality to enforce business rules, and give staff more direct access to data for reporting and monitoring.

Stakeholder Engagement

In the past year, OADS began a regional, Quarterly Stakeholder Meeting process. After recent discussions with stakeholders, this quarterly format is being replaced with more focused and frequent opportunities to interact.

-Developmental Services and Brain Injury stakeholders will see that OADS will participate in the monthly meetings of the Maine Coalition for Housing and Quality Services . We are also working on ways to enhance direct feedback from self-advocates.

-Regarding Aging and Long-Term Services and Supports programs, we have met with multiple stakeholder groups in the past month and are planning an Aging and Long-Term Services and Support Convening in early May. OADS expects to participate in regular stakeholder forums following the Convening.