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By Monica E. Oss

Greetings from sunny San Diego and the second day of the inaugural OPEN MINDS California Planning & Performance Management Institute! We’ve had an exciting day with an incredible faculty and a great group of sponsors.  Of the many sessions I attended, one with an “aha” moment for me was our session, Navigating The Challenges Of Serving Individuals With Intellectual & Developmental Disabilities: An Update On The Transitioning California Market.

flores-082114Our expert panel included three Regional Center Directors; Carlos Flores, Executive Director, San Diego Regional Center; Carol Fitzgibbons, Director, Inland Regional Center; and Javier Zaldivar, Director, San Andreas Regional Center. In California, Regional Centers are the designated non-profit private corporations that coordinate services and supports for individuals with developmental disabilities (including providing case management services) and contract with the organizations that provide consumer services. In this session, the directors took out their crystal balls to identify what they see as the key issues facing the $5 billion system in California – and the implications of those issues. Their picks for challenges ahead are:

  1. Self-determination
  2. Depopulation of the developmental centers
  3. Task force on the future of the developmental centers
  4. Reconvened developmental services task force
  5. Community crisis homes
  6. Behavioral support centers
  7. New federal home & community based services (HCBS) regulations
  8. Workforce Innovation & Opportunity Act

fitzgibbons-082114What caught my attention?  First, the shift to a new model of consumer self-determination.  A soon-to-launch pilot will allow 2,500 consumers to manage their own budgets over a three-year period and then open up the program to all consumers statewide. A fundamental element of the change is moving from the Regional Center vendor list and purchase of services, to consumer discretion in spending.

Another big shift is the closing of the residential developmental centers in California. There are five centers remaining, with one (Lanterman Development Center) scheduled for closing.  For some of the remaining centers, with greatly reduced numbers of residents, operating costs can top $400,000 per consumer per year – creating momentum for speeding this transition. All three regional directors spoke to the need for community partners to develop community capacity in this transition – particularly community partners with mental health expertise. This discussion of community partners brought up the issue of rates – and the need for rate reform in the near future.

zaldivar-082114A third area of very interesting discussion was the challenges of designing community residences. Under the waiver program, California regional centers are not allowed to pay for any locked residential environment with Medicaid funds – those programs are paid entirely through state funds. But the complicating factor was the lack of clarity about whether residences with delayed egress and secure perimeters are reimbursable under the waiver. (An issue that we will address in a future briefing.) The discussion of the unique needs of segments of the consumer population served by the Regional Center System – and how to address specific subpopulations – raised some opportunities ahead for entrepreneurial provider organizations.

The key questions raised in the session where:

  • How do you serve the individuals that have the most serious, complex conditions in the community? Can that level of care be provided outside of a facility?
  • How do you deal with individuals who are violent to themselves and to others? Can these individuals be kept out of jails, and if so, what type of facilities can serve these individuals?
  • What do you do with the physical facilities and grounds after the hospital/residential center is closed? Can that land be used to benefit the population that it was originally meant to serve in some other way?
  • How do you build more community capacity to serve individuals? How do you replicate the same types of programs and services that consumers need in a different setting?
  • What do community providers need to develop and provide services?

For more on the IDD market check out our briefing, The U.S. Intellectual & Developmental Disabilities Market: Almost Five Million People With Disabilities & $56 Billion In Annual Spending, or visit our Intellectual & Developmental Disabilities Services Market Library.  Or take a look at our recent coverage:

  1. New York To Open Applications For IDD Managed Care Entities
  2. Detroit-Wayne County Mental Health Authority Rebids Manager Of Comprehensive Provider Network Contracts
  3. Disability Rights Ohio Says State DD System Reliance On ICF/IDD Placements Violates ADA
  4. Connecticut Insurance Department Classifies Autism Behavioral Therapy As A Habilitative Essential Health Benefit
  5. Ohio Rolling Out CRM System To Improve Service Planning For Individuals With Developmental Disabilities
  6. Medicaid Funded $134 Billion, 61% Of U.S. Long-Term Services & Supports Spending In 2012

If you couldn’t join us here in San Diego for the California Planning & Performance Management Institute, follow our live updates on Twitter @openmindscircle #OMCA, or our Facebook page, https://www.facebook.com/openmindscircle.


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