Adults with Autism. Janet George Assistant Commissioner Policy, Planning January 9, 2016

Transcription

1 Adults with Autism Janet George Assistant Commissioner Policy, Planning January 9, 2016

2 Introduction and Objectives Background of Autism Omnibus Bill- Goals: Basic Demographics Eligibility Process Services Questions

3 Introduction The Autism Omnibus Legislation was signed into law in August The legislation required DDS to develop and implement revised eligibility processes and criteria for an expanded population of people with Autism and Prader-Willi without Intellectual Disability and for Smith Magenis Syndrome. The review process for eligibility began in November Revised regulations were required. They are currently in regulatory review process.

4 2014 Autism Omnibus Bill Highlights Autism Commission Report 2013 created structure for bill in 2014 Establishes Autism Commission as permanent body within EOHHS - Changes eligibility criteria for DDS **** Creates tax-free savings account (ABLE) Creates Autism endorsement for special education teachers Requires DDS and DMH to develop and implement plan for mental illness and developmental disabilities including respite, family support, and care coordination **** Requires MassHealth to cover medically necessary treatments for children under 21 years of age including ABA ****

5 Why The New Law? DDS Adult Eligibility only served those with ID Massachusetts was one of the few states that was an ID state, not a DD state Stakeholders and DDS saw that individuals with ASD were falling through the cracks

6 Requirements for Eligibility for ASD Be domiciled in Massachusetts 2. Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation for ASD completed by a qualified physician or psychologist, that includes standardized instruments. 4. When not provided a diagnostic assessment by qualified physician or psychologist detailing reasons

7 Adult Eligibility requirements Have substantial functional impairments in three or more areas of the seven major life areas 1. Self-care ( ADLS) 2. Expressive Communication 3. Receptive Communication 4. Learning 5. Mobility 6. Capacity for Self-direction 7. Economic Self- Sufficiency

8 Requirements cont. Adaptive Measures required Additional information may be needed Provide documentation and information that demonstrates ASD manifested prior to age 22 Provide documentation that demonstrates that the developmental disability is likely to continue indefinitely Provide personal, clinical, psychological medical, and educational records that diagnosis was through psychiatric and psychological assessments Provide reports of previous adaptive measures Although IQ is not determinative factor helps delineate strengths and weaknesses

9 What is a reliable diagnosis of ASD for adults? Full psychological evaluation as a child with differential dx and use of ASD scales, from a qualified practitioner. Evaluation by a hospital based developmental clinic Well documented history of ASD symptoms from multiple reliable sources: (pediatrician, school, therapists, psychosocial history)

10 Demographics Currently there are 454 individuals, aged 18 or older, who have been found eligible under the new regulations. 205 are over 22 and 245 are between 18 and 21 years old. Of those 205 individuals, 101 individuals are receiving a total of 224 DDS services Of the total service enrollments, 18% of the services are being provided through Participant Directed or Agency with Choice; while the remaining individuals are enrolled in traditional Purchase of Service There individuals with Autism age 22+ who DDS staff continue to work with and who have service enrollments pending at this time

11 Autism Eligible Adults Between Years Old 245 individuals are between the ages of While the eligibility for adult services occurs at age 22, there are circumstances where individuals aged may be receiving services, such as employment and/or day services and Family Support Services. Individuals no longer in school as well as those determined to need the service prior to 22 may be enrolled. 79 of these individuals are enrolled in a combination of 104 services.

12 Supports Intensity Scale Life Activity Subscales: Support is a combination of type, frequency and daily support time. Home Living Activities Community Life Long Learning Employment Health and Safety Social Each item is phrased: If the individual were to engage in this activity over the next few months, what type of support would he or she need to be successful? Protection and Advocacy Exceptional Medical and Exceptional Behavioral

13 How Does the SIS Measure Success? Comparable to the typical adults without disability Individual + Supports = Success

14 Service Array DDS provides: Service Coordination Variety of Employment Supports and Activities During the Day Variety of Family Supports for Individuals Residing in the Family Home Variety of Individual Types of Supports Variety of Goods and Services Limited array of housing supports for individuals with severe challenges Exploring new service options based on needs

15 Infrastructure In order to implement the legislative requirements, DDS needed to strengthen its infrastructure. Additional staff were added to the Regional Intake and Eligibility Teams. An Autism Service Coordinator was added to each Area Office. Regional Program Coordinator Positions were added. Regional Contract Specialist Positions were added. A Data Management System was developed that tracks eligible individuals on a monthly basis, as well as individuals served and individuals in planning. A Fiscal Monitoring System was put in place to monitor the $12.6 million appropriation with additional work underway to track expenditures by service category.

16 Collaboration with DMH Establish joint DDS and DMH training, eligibility determination, and service development Collaborate with other state agencies, insurance payers, stakeholders, & families for needed comprehensive services Encourage Autism Centers of Excellence for access to skilled care for co-occurring behavioral health needs Develop family supports including respite & care coordination DDS and DMH have entered into an Interagency Service Agreement to collaborate in the development and funding of supports and services for individuals who are eligible for service in both systems.

17 DDS/DMH ISA Key highlights: Collaboration at all levels Commitment to work together Better understanding of perspectives Dual eligibility Decision making process for case management assignment Forensic Capacity Psychiatric Consultation Psychiatric Fellowships Co-Central Office Leadership Team Engagement of Joint Community Providers Demonstrations/Pilots for New Service Models

18 Collaboration with DMH (continued) DDS and DMH are learning the similarities and differences between the respective agencies through regular local, regional and central office networking Agencies commit to joint trainings, service design and implementation and mutual consultation. Joint Provider Meeting occurred in November 2014 DDS will purchase and support additional clinical resources from DMH including: Two psychiatric fellowships ( Mass General and UMass) Short term psychiatric consultation Forensic Risk Consultation Development of Joint Training Agenda

19 Training Plan To expand the knowledge based at DDS, DMH and the provider community, a variety of training opportunities as occurred. a series of three trainings for the new autism service coordinators, staff from DMH and providers from ADDP were provided. These trainings were provided by prominent external experts and paid for by the SEIU. There has been joint training with DMH regarding each agency s eligibility determination and service delivery systems. There has been a joint DMH/DDS provider meeting DDS has participated in a workgroup established by the Association of Developmental Disabilities Program to examine current services, promote new supports and provide training opportunities.

20 Questions?? Suggestions?? Contact: