FY 2012 Community Integration (Olmstead) Performance Measures

1. Conduct 3 outreach activities quarterly (including service provider fairs, inter-agency liaison assignments, and relationship building with community resources).
2. Reduce the number of people receiving DDA services in congregate settings by ten (10) individuals in FY 2012. These individuals will transition to community-based placements where they will receive needed support services.
3. Divert the placement of ten (10) individuals eligible for DDA services into institutional settings in FY 2012 through effective service planning and delivery of community-based services and supports.
4. Increase the number of qualified providers by four (4) in FY 2012 to meet identified service gaps.

FY 2012 Community Integration (Olmstead) Initiative Outline

Agency Mission

The mission of the Department on Disability Services (DDS) is to provide innovative, high quality services that enable people with disabilities to lead meaningful and productive lives as vital members of their families, schools, workplaces and communities in every neighborhood in the District of Columbia. The Department is comprised of the Rehabilitation Services Administration (RSA) and the Developmental Disabilities Administration (DDA).

The Developmental Disabilities Administration (DDA) is responsible for the oversight and coordination of all services and supports provided to all qualified persons with intellectual disabilities in the District of Columbia. Intellectual disability is a disability characterized by significant limitations both in intellectual functioning (reasoning, learning, problem solving) and in adaptive behavior, which covers a range of everyday social and practical skills. The age of onset of an intellectual disability is prior to the age of 18. To be eligible for services from DDA, a person must have a diagnosis of an intellectual disability. Many persons receiving DDA services also are considered to have developmental disabilities. Developmental disabilities include a range of significant, life-long behavioral, intellectual and/or physical conditions. National prevalence data indicate that nearly one half of all persons with intellectual also have developmental disabilities. Other disabilities that may result in developmental disabilities include: cerebral palsy, Down’s syndrome, autism and other significant life-long impairments that occur before the age of 22. Some people with developmental disabilities also have significant medical or mental health needs.

DDA provides leadership, oversight and policy direction for the District’s Developmental Disabilities Services system. DDA delivers service coordination services for all individuals in the DC Developmental Disabilities Service system, is the operating agency for the Medicaid IDD Home and Community-Based Services Waiver Program, coordinates admission into the Intermediate Care Facilities for persons with Intellectual Disabilities (ICF/ID) program certified by the Department of Health, and operates an on-going program of quality assurance and improvement over the District’s overall Developmental Disabilities Services system. The DDA Office of the Deputy Director is responsible for policy development and leadership in areas of best practice, performance management, and strategic planning. The Department on Disability Services provides administrative support and is responsible for budget authority, quality management and compliance with CMS and Evans v. Gray requirements and contracts and procurement.

Vision

The Department on Disability Services Developmental Disabilities Administration (DDS/DDA) is making great strides in its efforts to provide District residents with intellectual and developmental disabilities with the services and supports necessary to enable people to live in the most integrated setting appropriate to their needs. Until recently, the vast majority of persons receiving DDA services lived in restrictive ICF/DD settings. This is no longer true. Over the past two years, DDA has increased its capacity to enroll and serve persons in the Medicaid HCBS waiver and the number of people served as a result of this has grown. On December 31, 2011, DDA served 1,502 individuals with developmental and intellectual disabilities through the Medicaid HCBS waiver.

Agency’s Population and the Definition of this Population

1. Number of people currently living in these institutions - DDS/DDA has 370 people living in ICF/IDD facilities as of December 31, 2011.
2. Number of individuals who are currently residing in out-of-state institutions and in-state institutions – DDS/DDA has twenty-one (21) people residing in out-of-state settings not classified as community-based integrated settings.
3. Over the last two fiscal years Department on Disability Services / Developmental Disabilities Administration has averaged diverting and/or has returned 100 people to the community with the appropriate supports. This is accomplished through Home and Community-Based Services (HCBS) waiver enrollment and through the Money Follows the Person program in collaboration with the Department of Health Care Finance

Agency’s Barriers Unique to each Population

• Housing – accessible, affordable housing in safe neighborhoods.
• Transportation – Medicaid funded transportation reliability.
• Due to the unique medical and behavioral challenges faced by the people who are placed out-of-state, the District has historically struggled to find providers with the unique expertise needed to support these individuals. DDS/DDA has enhanced its provider development as well as recruitment to ensure those providers deemed qualified have the expertise required to serve the people who will be returning to the district.
• Home and Community-Based Services (HCBS) waiver service options- access to funded skilled nursing services in community-based settings

Service Needs that Challenged the Agency to Comply with the Olmstead Initiative

DDS/DDA is in the process of building the infrastructure to develop a self-determination process, which accommodates quality assurance and improvement components. DDS is collaborating with Department of Health, Health Regulatory and Licensure Administration (DOH/HRLA) to ensure appropriate licensing regulations are in place which supports community-based service options. DDS is collaborating with the Department of Health Care Financing (DHCF) in the development of the DDA HCBS waiver renewal and a second DDA Supports HCBS waiver to advance self-direction.