Independence Plus Initiative
CONNECTICUT
Target Population
All individuals who seek substantive funding from the Department of Mental Retardation (DMR).
Severe disabilities: Yes.
Geographic Focus
Statewide.
Primary Focus
- The grant will focus on the Independence Plus (IP) design feature of individual budgeting to enhance the ability of individuals and families to self-direct their own supports, by developing a valid and reliable method to predict level of need and establish individual budgets.
- The project will also use the individual budget methodology to design a template and submit an application for an Independent Plus waiver.
Goals, Objectives, and Activities
Goal: Establish a steering committee inclusive of all stakeholders to guide the design, research, and implementation of the level of need project leading to individual budgets.
Objectives/Activities
- Identify members and support individuals and families to participate in meetings, informational sessions, and presentations.
- The steering committee will provide ongoing direction and feedback for all goals established in the project.
- The steering committee will assist the project director and key staff to develop a plan for sustainability and assure that steps toward allocating financial and personnel resources and processes are in place as the activities of the grant progress.
Goal: Establish a valid and reliable methodology to predict level of need, and establish a valid and reliable methodology to compute consumer costs associated with particular levels of need.
Objectives/Activities
- Construct a baseline level of need database using preexisting data, and construct baseline level of cost data for a select DMR population.
- Clean data and prepare data for analysis.
- Produce level of need classification table and produce cost estimates associated with level of need.
- Conduct about 200 individual evaluations to determine if there is concordance between present level of reimbursement and appropriate levels of reimbursement.
- Compute five final level of need models and cost models.
- Identify and train appropriate staff on the use of the level of need and cost algorithm.
Goal: Initiate new Individual Budgeting process for individuals and incorporate methods into resource allocation strategies.
Objectives/Activities
- Implement individual budgeting methodology for all new individuals seeking to self-direct, and include a process for adjusting the actual Individual Budget through a review process based on the individual service plan. This will act as a safeguard while DMR accumulates experience and additional data on the methodology and implementation.
- Develop an implementation plan for the application of individual budgeting methodology to individuals already receiving funded support, for the purpose of identifying potentially over- or under-served individuals and developing a strategic plan to respond to that population accordingly.
- Develop budget forecasts to address results of analysis for both individuals in service and those waiting for funded service.
Goal: Incorporate the final level of need assessment tool methodology and associated individual budgeting mechanisms in the preparation of an IP waiver submission.
Objectives/Activities
- Determine level of need requirements for admission to waiver.
- Conduct focus groups on content and complete draft for public comment.
- Incorporate comment and submit application for approval by the State Legislature.
- Propose budget option to the Office of Policy and Management (OPM)the Governor's budget officeto support the waiver.
- Submit waiver application to Centers for Medicare & Medicaid Services (CMS).
Key Activities and Products
- Conduct meetings, informational sessions, and presentations for the grant's steering committee.
- Produce level of need classification table and associated cost estimates, establish concurrent validity, and compute five final level of need models and cost models.
- Train staff on the use of the level of need and cost algorithm.
- Develop and implement an enhanced methodology to assist policy makers in assessing support and funding needs of individual consumers.
- Develop the necessary level of need and individual budgeting methodologies to submit a second waiver under the IP initiative.
- Products will include a database, an algorithm model, a training manual, an individual budget template, strategic plans and budget forecasts, policies and procedures, and a completed waiver application.
Consumer Partners and their Involvement in Implementation Activities
- A steering committee will be established for this project comprising consumers and family members, representatives from State agencies and provider associations, and representatives from self-advocacy groups.
- All stages of each project goal will be guided by the steering committee to assure a product that will be embraced by all key stakeholders in the system.
- Status reports will be prepared by staff responsible for grant goals and objectives with the assistance of participating consumers and family members.
Public and Private Partners and their Involvement in Implementation Activities
Public Partners
Representatives from the State Council on Mental Retardation, the Office of Protection and Advocacy, the DMR's Self-Advocacy Council, the Department of Social Services (the Single State Medicaid Agency), and the Office of Policy and Management will provide ongoing direction and feedback on all aspects of grant implementation and evaluation through membership of the grant's steering committee.
Private Partners
- Representatives from the Connecticut Family Support Council, the Family Support Networks, the Connecticut Association of Nonprofits, the Connecticut Community Providers Association, and the Connecticut Arc will provide ongoing direction and feedback on all aspects of grant implementation and evaluation through membership of the grant's steering committee.
- The Braceland Center for Mental Health and Aging, one of four Centers of Excellence located at the Institute of Living/Hartford Hospital, will conduct the analysis of data and develop the methodology to predict level of need and compute individual budgets.
Advisory Body, Committee, or Task Force
- The steering committee, composed of the wide array of stakeholders listed in the partnership section above, will assist the project director in grant administration.
- The steering committee will meet bi-weekly or bi-monthly to inform the design phase of the project and to review progress reports on work plan activities provided by project staff and the researcher.
Formative/Process Evaluation Activities
- The Braceland Center for Mental Health and Aging will meet with the project staff on a monthly basis to report progress and barriers and to seek additional guidance on the direction of the research, based on preliminary results.
- To determine whether the performance of the model is sufficiently stable over time, the researcher will examine data at two unique 6month intervals. This technique will address possible changes in public policy over time, in addition to changes in case mix for individual group homes and other program settings.
- Examples of the variables to be incorporated include: age; gender; ethnicity; level of mental retardation; communication, hearing, vision, and eating abilities; psychiatric diagnosis; and medication classification. In addition, a number of geographic and program specific variables exist in the data system, which will play a modest role in the level of need computation, but a major role in the development of cost models. Some of these variables include: type of living arrangement, location of residence (zip code), region of residence, type of residence, and residence size.
- The steering committee, in conjunction with key project staff, will analyze on an ongoing basis the activities that have been successful and can be built upon; the barriers that are encountered, how barriers can be reduced or eliminated, and by whom; and the actions and strategies that are still needed to reach the stated goals.
- Information from this ongoing evaluation and reflective learning process will be shared with stakeholders at large through regularly occurring meetings at the State and regional levels, and on a periodic basis through specially scheduled learning network meetings for various stakeholder groups and department managers and supervisors, to solicit further input and feedback on performance related to the grant activities and for overall systems improvement.
Summative/Outcome Evaluation Activities
- The Braceland Center will conduct key informant interviews upon completion of the level of need tool and individual budgeting methodology to gauge response from the stakeholders on the process and their views on the product.
- The researchers will produce a final report for public comment and discussion, and make modifications to the report as appropriate.
- The research team will conduct public presentations on the research and products, and publish in appropriate venues upon approval from CMS and with the appropriate acknowledgements.
Strategies to Ensure Sustainability
- Inclusion of individual consumers and their families in significant policy arenas, such as resource allocation, will enhance the likelihood that they will continue to participate in directing the future of the Department.
- This project will have implications for addressing the State's waiting list as it will inform the participants in this project about costs and resource decisions, leading to improved advocacy efforts and improved value of services.
- DMR is committed to including the private provider community in this project as resource decisions directly impact the viability of existing and future provider networks.
- DMR will assume the financial and resource responsibility for providing training for department staff and all stakeholders in the use of and rationale behind the level of need assessment process and individual budget tool.
- DMR will project the need for funds to support the ongoing need for consultation to update and validate the level of need assessment and individual budget methodologies beyond the term of the grant.
- DMR will conduct analysis of department policies and procedures, and develop or revise where needed to support the broader systems change objective to maximize the ability of individuals and families to self-direct their services and supports.
- DMR will incorporate the results of this project into both the existing 1915(c) mental retardation home and community-based services (HCBS) waiver and the new IP waiver, both of which will have significant impact on the operation of the system at large.
- DMR will continue to contract out an independent review of the resource allocation methods after the grant term has expired, to identify need for revision and strengthen public confidence in the process.