Spring reminds me of the new future we are looking toward as we respond to several different and still-emerging national and state issues that are changing the landscape of DD Services in Ohio. It also reminds me of my promise to keep you updated. We are nearing a crucial point of significant change to the traditional ways that services have been delivered.

Much is still unknown, particularly about the enforcement of the Olmstead Act of 1999 by the Department of Justice and Disability Rights Ohio, and Gov. Kasich's Employment First Initiative and 2015-2016 Budget proposals. Much is still also unknown related to the various parts of the Centers for Medicaid (CMS) Rule and the Ohio Department of DD's Transition Plan to comply with it.

However, one part of the CMS rule known as "conflict free case management" for home and community-based services waivers (Medicaid waivers) is heating up. We must now focus on preparing for its impact, which we expect to be significant in Hamilton County and throughout Ohio.

Conflict free case management means that providers of Medicaid waiver services cannot provide case management or develop the person-centered service plan, known as the ISP. In Hamilton County and throughout Ohio, Service and Support Administrators oversee what CMS calls case management. We are currently and have for many years been providers of Medicaid waiver day services for adults.

The Ohio Department of DD has advocated with CMS for less restrictive interpretations of this rule with no success. CMS continues to push for County Boards of DD to phase out their role as direct service providers in the upcoming years. What this means for Hamilton County DD Services and other boards in Ohio is that adult centers will be impacted. We must make some tough decisions to comply.

The clock started ticking on this rule in March 2014, and we have four more years to plan and comply. What compliance looks like is still up for debate and no decisions have been made. Though the Ohio Department of DD (DODD) submitted its statewide Transition Plan to CMS, we've not heard back from the federal officials and their response may still be weeks or months away. To learn more about the CMS rule and its impact on Ohio's system of services for people with DD, click here:  CMS Transition Plan.

Another issue receiving much attention in our world is Ohio Gov. John Kasich's 2015-2016 budget proposal. Media reports and other communications have indicated the proposal contains increased funding for DD services and waivers. However, additional information indicates that many of the state-funded waivers in the budget are not for new services. They are for people in Intermediate Care Facilities (ICF/DD) and Developmental Centers to comply with Olmstead and the CMS Rule. The budget proposal won't be final until the end of June.

Another item in the budget proposal relates to independent providers. A public hearing in the Ohio House of Representatives on the budget in March drew many families of people served to share their concerns about this. Their messages did have some impact on the proposal in the House. 

We don't yet know what the Ohio Senate will decide. Read more about the results of the public hearings through the Ohio House and the budget and process by clicking here: DODD Pipeline Extra.

In addition to all of that, a couple other issues have emerged that will also impact us in ways we don't yet know. One is the federal Transition to Integrated and Meaningful Employment (TIME) Act. If passed, it will phase out special wage certificates under the Fair Labor Standards Act (FSLA) which would mean people with disabilities can no longer be employed at lower minimum wage rates.  

Another is the Workforce Innovation and Opportunity Act, which limits enrollment in adult centers unless the person is at least age 25 and has explored work options.

Changes to our local and state system of services are driving our future to look different than our past. We know we have to change, and that services will likely be delivered in different places and in different ways. But we are not going away and will continue to keep focused on what is best for each person served as we walk through this together. We will keep you informed!

Alice C. Pavey