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Dear DDA Stakeholder:
It has been six months since I sent out a message with some highlights of what DDA received in the 2023-25 biennial operating budget Engrossed Substitute Senate Bill 5187. We continue to be delighted that the Legislature and the governor continue to support clients, families, providers and the workforce who support our clients.
I am pleased to share updates on the progress the hardworking teams at DDA have made on implementing the significant policy bills:
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Engrossed Second Substitute House Bill 1188 Child Welfare Services: DSHS is funded to seek federal approval to expand the existing Medicaid waivers to dependent children and youth with developmental disabilities. UPDATE: DDA is on track to submit waiver amendments to the Centers for Medicare and Medicaid Services on Jan. 2, 2024. Public comments on the draft waiver amendments closed on Nov. 2, 2023 and our tribal partners had until Dec. 2, 2023 to make comments. We will continue to work with our teammates at the Department of Children Youth and Families to respond to comments and edit our draft amendments as needed to be ready for a Jan. 2 submission. We anticipate CMS will approve dependent children to receive waiver services by September 2024.
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House Bill 1407 Maintaining Service Eligibility: Funding is provided to update DDA eligibility rules so that clients who are made eligible between age 3 and 17 do not lose eligibility or need redetermination of eligibility. UPDATE: The Intake and Eligibility teams implemented these changes early and stopped reviewing the eligibility of 10 year olds in June. Families affected by this change received letters telling them that eligibility would not be reviewed again until age 20.
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Second Substitute House Bill 1580 Children in Crisis: One-time funding is provided to create a Multisystem Care Coordinator within the Office of the Governor and a Rapid Care Team composed of representatives from multiple agencies. UPDATE: DDA has hired a Hospitalized Children's Program Manager effective through expiration of the bill on June 30, 2025, to participate in collaboration with the Health Care Authority, the Department of Children Youth and Families, and the Office of Financial Management under the leadership of the Multisystem Care Coordinator to address the support needs for youth in crisis. Currently, DDA participates in multi-system conversations with representatives from DCYF, Health Care Authority, and the Managed Care Organizations to discuss children whose support needs are unmet, and will work to replicate similar multi-system processes with the rapid care team as defined in law.
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Engrossed Second Substitute House Bill 1694 Home Care Worker Shortage: Modifies training and certification requirements for home care workers. It also directs DDA to conduct a feasibility study for how to pay parent caregivers of children with complex needs. UPDATE: The rule changes are already in effect and individual providers caring only for their sibling, aunt, uncle, cousin, niece, nephew, grandparent or grandchild, including when related by marriage or domestic partnership, no longer have to be certified as Home Care Aides. They must complete Safety and Orientation and 30 hours of training. Additionally, the report about the feasibility of paying parents of minor children is complete and will be published by Dec. 31, 2023.
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Engrossed Second Substitute Senate Bill 5440 Competency Evaluations and Restoration: Funding is provided for DSHS to provide housing and wrap around services for individuals found incompetent to stand trial due to an intellectual or developmental disability, traumatic brain injury, or dementia to receive services and supports in community-based settings. UPDATE: Implementation of these new services is well underway. This new program is called the Civil Transitions Program. Resources, policies, and procedures are being developed with regional teams who will be doing the work with these individuals and communication is occurring consistently. DDA has already received a few referrals and is helping to support those individuals while preparing to implement the program in December 2023.
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Community Supports for Children: Funding is provided to continue the phase-in of one, three-bed intensive habilitation services facility and six, three-bed enhanced out-of-home services facilities. Intensive Habilitation Services will provide short-term, up to 90 days, placements for children and youth aged eight to 21. E-OHS will provide long-term services to support youth aged 12 to 21 who have discharged from inpatient care. UPDATE: There is one new 3 bed IHS contracted facility in Spokane ready to begin service delivery on Dec. 18, 2023. There are 3 youth who have transitioned from inpatient care and receiving E-OHS.
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Non-citizen Program: Funding is provided to establish 33 slots at an average rate of $278 per client per day for individuals with intellectual or developmental disabilities who are ineligible for Medicaid due to citizenship status. Priority must be given to clients in acute care hospitals. UPDATE: Program staff at DDA have collaborated closely with program staff at DSHS' Aging and Long-Term Support Administration to identify the DDA eligible clients currently enrolled in the program and on the waitlist. Clients who are DDA eligible will be served by DDA beginning Jan. 1, 2024.
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Complex Needs Enhanced Rate Pilot: Funding is provided to pilot an enhanced daily rate of $450 per client per day for community residential providers who receive additional training to support individuals with complex physical and behavioral health needs. Funding is sufficient to serve 30 clients. UPDATE: The target population for this pilot are individuals who are at risk of being hospitalized or are discharging from a hospital. We have commitment from three providers to join the pilot and are meeting with several others in the next week. We have a several individuals who will be entering service by early January.
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Enhanced Adult Family Homes Specialty Pilot: Funding is provided to pilot a specialty AFH contract to serve up to 100 individuals with intellectual or developmental disabilities who may also have co-occurring health or behavioral diagnoses. UPDATE: In September 2023, we started the pilot with three AFHs and 16 clients statewide. We will continue to contract with specific AFHs. Our goal is to add 16 clients per month to the pilot until we reach the budgeted target of 100 clients. It is our goal to maintain 100 clients until the end of the 2023-25 biennium. We will collect data throughout the pilot and provide the Legislature with a detailed report of our findings. The report is due in December 2024. For more information check out the DDA Specialty AFH Pilot Fact Sheet Fact Sheet.
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Enhanced Behavior Support Specialty: Funding is provided to develop a plan for implementing an enhanced behavior support specialty contract to provide intensive behavioral services and supports to adults with intellectual and developmental disabilities in community residential settings. UPDATE: This project is in the planning stage and will get underway soon.
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Study to Expand Medicaid Services: One-time funding is provided to study opportunities to restructure services offered under DDA’s Medicaid waivers. UPDATE: DDA has contracted with an entity to facilitate information gathering conversations with interested parties, including individuals currently receiving services, their family members, providers, advocates, our tribal partners and DDA staff. DDA will also consult with a national organization experienced with home and community based waivers in other states. These conversations will occur between January and June so the report can be written and published by Dec. 1, 2024.
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Assessment Tool Study: Funding is provided for a feasibility study to identify opportunities to improve the Comprehensive Assessment Reporting Evaluation system. The feasibility study must include an assessment of the system's questions, processes, workflows and underlying technology. UPDATE: Project initiation is underway. There will be two contractors to assist in developing the study. The first contractor will conduct information gathering sessions from interested parties, create organization change management and impacts, and will create the final report to the legislature. The second contractor will conduct technical research on the existing DDA Assessment and on other systems nationwide that could provide alternatives and efficiency recommendations to be included into the final report.
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Dan Thompson Memorial Account: Expenditure authority from the Developmental Disabilities Community Services Account (also known as the Dan Thompson Memorial Account) is shifted from the 2021-23 biennium for projects to enhance and expand Home and Community Based Services for individuals with intellectual and developmental disabilities. UPDATE: During the 21-23 biennial budget, DDA, in conjunction with the Department of Commerce, authorized approximately $21.8 million in supports and services for individuals with I/DD using funding from the Dan Thompson Memorial Account. The Legislature appropriated $32 million in the 23-25 biennial budget. While DDA is executing the final contracts from the original application round, we are also preparing for round two applications with approximately $4.5 million left to be awarded. A new application, guidance document with grant writing resources, and technical assistance sessions are being developed for distribution of the remaining funding to be spent by June 30, 2025. Contracts for current awardees are vast and include examples such as: developing peer mentor programs, purchasing specialized and adaptive equipment to be used in community settings, lending libraries, housing assessments and resources, and videos developed by tribal members to explain DDA services.
More detail can be found at the OFM budget website.
Thank you for your partnership as we focus on implementing these items. We will continue to work each day to transform lives by providing support and fostering partnerships that empower people to live the lives they want.
Sincerely,
Dr. Tonik Joseph
Assistant Secretary, Developmental Disabilities Administration
DSHS: Transforming Lives
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