I recently attended ANCOR’s Annual Conference in Chicago featuring the theme Get Smart! Get Inspired! Get it Done!, and it certainly had content on each of these areas for the I/DD provider community. Starting with getting inspired, I have to give a plug for New York Times columnist Dan Barry’s forthcoming book The Boys in the Bunkhouse: Servitude and Salvation in the Heartland. Dan was one of the keynote speakers, and as he said, you have to read the book, but he reminds us how easy it is to “not see” something right in front of you. People with intellectual and developmental disabilities are often the most marginalized, and we can never let our focus slip as we strive to ensure equal rights and full inclusion for all.
As we all know in the I/DD field, changes in Medicaid, from the passage of the 2014 HCBS Settings Rule to the steady march of Managed Care in Long-Term Services and Supports, have given providers new challenges to understand and the necessity to adapt if they are to ensure continued success and organizational health. The conference provided plenty of resources and opportunities for discussion around the HCBS Settings Rule, including a full Pre-Conference Day on Provider Transformation presented by my colleagues Rachel Pollock with Job Path, Inc., Genni Sasnett, ICI at UMASS Boston, and Dale Verstegen with Transcen, Inc., where traditional day and providers received top notch technical assistance in working through how to imagine and plan for service delivery outside of the box/building! The new Director of the Medicaid Disabled and Elderly Programs Group, Michael Nardone, provided the attendees with an update on the Statewide Transition Plans, the documents each state must submit to CMS detailing the systemic and site specific assessment of each HCBS program’s compliance with the Settings Rule, how the state intends to rectify any service or setting that is not in compliance, and the process that will be used to trigger what is called “heightened scrutiny.” All of this information must be submitted prior to March 2019 and it is crucial that providers are involved in their state’s Transition Plan process, either directly as part of working teams or through the required public input process. To find your state’s Transition Plan, go to your state Medicaid or DD agency’s website, or, you can go to CMS.gov and search Transition Plans where you will find each state’s Transition Plan documents to learn more.
Lastly, I have to talk about the need in our field to transition from a service-based system to an outcomes-based system. While you will hear that language from those talking about managed care and value based purchasing, it is not just about managed care. It is about providing quality services that can be evaluated by whether or not the people you support are achieving the outcomes they value as a result of the service you provide. More and more, state agencies will be looking to evaluate provider agencies on performance, managed care organizations will introduce pay-for-performance contracting, and people and families will just plain demand it when they make decisions about which provider they should choose to provide the support they have been fortunate enough to receive. It will be just as critical that provider agencies can easily demonstrate and analyze on their own whether personal outcomes are being achieved based on the person-centered plan. To do that, you have to have an electronic record system, there is just no way around it. Not only will it make tracking, monitoring and reporting on personal outcomes easy, it will help your agency evaluate your own organizational and personnel performance.
There are a lot of challenges facing I/DD providers today and more likely looming in the future. But, our field has been leading the way in providing person-centered and community-based services and there is no reason to think we will stop now. Stay informed, involved, inspired!