Adults with Autism Janet George, Ed.D. Assistant Commissioner Policy, Planning February 4, 2017
Introduction and Objectives Background of Autism Omnibus Bill- Goals: Basic Demographics Eligibility Process Services Questions
Introduction The Autism Omnibus Legislation was signed into law in August 2014. 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 2014. Revised regulations were required. Can be found at CMR 115. 2.0 and 6.0
2014 Autism Omnibus Bill Highlights Autism Commission Report 2013 created structure for bill in 2014 Established Autism Commission as permanent body within EOHHS - Changed eligibility criteria for DDS **** Created tax-free savings account (ABLE) Created Autism endorsement for special education teachers Required DDS and DMH to develop and implement plan for mental illness and developmental disabilities including respite, family support, and care coordination **** Required MassHealth to cover medically necessary treatments for children under 21 years of age including ABA ****
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
Requirements for Eligibility for ASD 1. 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. If a diagnostic assessment without standardized instruments is not available a detailed report by qualified physician or psychologist detailing reasons is needed
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
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
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)
Demographics Currently there are 1010 newly eligible individuals, aged 18 or older, who have been found eligible under the new regulations. 519 are over 22 and 491 are between 18 and 21 years old. Of those 519 individuals, 270 individuals are receiving a total of 742 DDS services Of the total service enrollments, 21 % 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 are @ 99 individuals with Autism age 22+ who have not requested any DDS Services. As utilization savings are identified additional individuals will receive services.
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 Procured coaching service pilot statewide DMH Club Houses potential option
Frequent Service Requests Employment supports Respite Individual Support Stipends Adult Companion All receive Adult ASD Service Coordination Individuals receive multiple services
Autism Eligible Adults Between 18-21 Years Old 491 individuals are between the ages of 18-21. While the eligibility for adult services occurs at age 22, there are circumstances where individuals aged 18-21 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. 148 of these individuals are enrolled in a combination of 601services. 96 individuals have not requested a service. As utilization savings identified, additional individuals added
Frequent Services Stipends Adult Companion Family Navigation Intensive Family Support
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
How Does the SIS Measure Success? Comparable to the typical adults without disability Individual + Supports = Success
Important of SIS Participation Post eligibility Helps inform service planning and service needs Is strength based Likely to be used for prioritization in the future Assists DDS to determine service needs in the aggregate
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.
Collaboration with DMH Established joint DDS and DMH training, eligibility determination, and service development Collaborated with other state agencies, insurance payers, stakeholders, & families for needed comprehensive services Develop family supports including respite & care coordination DDS and DMH 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.
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
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. Multiple Joint Provider Meetings have occurred DDS has purchase and supported 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
Questions?? Suggestions?? Contact: janet.george@state.ma.us