Maryland Developmental Disabilities Administration
Creating a flexible, person-centered, family-oriented system of supports so people can have full lives. 
DDA Transformation Update
The DDA Transformation Newsletter | September 19, 2018 8
Alignment Status Update
To ensure that services and rates are properly aligned with needs of people in services, the Developmental Disabilities Administration (DDA) will delay the implementation from July 1 ,2019 to Jan. 1, 2020.
This new implementation date will ensure adequate time to review and verify the data (from the Bureau of Labor Statistics, training, transportation, and geographical differences) used to develop the rates. It will also allow time to finalize how the rates and services will be operationalized.  
Waiver Services  
DDA will be submitting program related amendments to the DDA Medicaid Waivers in the next six months. The amendments will serve multiple purposes including: aligning service descriptions and requirements across the three programs, adjusting new service start date and service transition dates due to additional time being dedicated to the Rate Study, adding stand-alone enhanced services (1:1 and 2:1 ratios of care), and supporting additional nurse delegation under residential services.  Additional amendments will be submitted in the future to adjust rates once the new rates are finalized. Stay tuned for more information.
Rate Setting
Phase Two of this effort consists of validating how the General Ledgers were coded, how they formed the basis for the cost components, and what assumptions were used to develop the rates. DDA recently contracted with Optumas Health Care Reform Consulting to finalize this phase. They are expected to complete their work within the next two to three months. DDA will develop a system-wide fiscal impact. Thereafter, rates will be piloted to ensure accuracy, and additional feedback will be obtained prior to final implementation.
B ack in June of this year, DDA regional office staff began on-site validation of non-residential site self-assessments that were completed by all DDA providers back in late 2016. Non-residential sites visited have included both Day Habilitation and Vocational. Surveyors used a non-residential site validation tool that closely followed information asked in the original self-assessments. 
The non-residential site validation tools were designed to determine whether a particular licensed site is currently in compliance with the Centers for Medicare and Medicaid Services (CMS)  final rule , and to provide potential recommendations on what action items a provider needs to take in order to be compliant. This rule was issued to ensure that Medicaid’s Home and Community-Based Services (HCBS) provide full access to the benefits of community living and offer services in the most integrated settings.
The DDA must complete approximately 400 non-residential site visits. To date, regional offices have completed most of these visits. The number of non-residential site visits that still need to occur, have been broken down by regions:
·          Southern Region: Two
·         Western Region: Eight 
·         Eastern Shore Region: All site visits have been completed
·         Central Region: Forty-nine
As new or existing providers apply to open new site-based services (Day Habilitation or Career Exploration: Facility-Based), DDA will use the same tool to determine compliance, prior to approval. This also holds true for existing providers wishing to provide site-based services under the new Community-Supports Waiver.
Once a visit has been completed, providers will receive a copy of the validation tool, along with a letter outlining compliance or non-compliance. If a site is currently found not in compliance, the letter will include recommendations, as well as further guidance if needed. The DDA will continue to work with providers to identify appropriate technical assistance and resources in order to comply with the final rule by 2021.
The next phase of site validations will begin in November, as DDA regional staff begin residential site validation. A formal memo outlining the process, as well as guidance, will go out to providers and stakeholders in the coming weeks.  
Person- Centered Planning (PCP)
DDA has worked collaboratively with people receiving services and their family members and advocates, stakeholders, targeted case management agency members, and policy drivers over the last two years to enhance the PCP process for people receiving services in Maryland. The new PCPtemplate, released earlier this year, highlights what is important to and for the person receiving services, and encourages year-long proactive communication between their team members to ensure that established outcomes towards their good life are realized through well-developed goals.

To this end, continued clarification of expectations are being communicated. DDA has met with providers and Coordinators of Community Services (CCS) to identify challenges to successful planning meetingsand timely submission of plans. DDA continues to transform its oversight, monitoring, and provision of technical assistance to ensure quality service delivery. In partnership with the Office of Health Care Quality, DDA is in the process of certifying that DDA’s policies governing the PCP process are aligned with COMAR regulations. 
Long-Term Services and Supports (LTSS)
LTSS Release 1 functionality continues to be used daily by the Coordinator of Community Services ( CCS) and DDA staff across the state, to manage the DDA eligibility process, monitor service provision, and document Person-Centered plans. Over the last month and half, we have worked diligently to clarify new processes with users and to resolve system issues. As we move forward, we will continue to partner with our CCS agencies to identify and resolve any lingering system concerns, while working to progressively improve and enhance functionality in LTSS.
As a foundational element of DDA’s transformation of policies and processes, LTSS is key to creating a more flexible, person-centered, and family-oriented system of supports so that people can have full lives. As we move forward with the transformation and continue adding new functionality to LTSS, we are excited to continue our ongoing partnership and engagement  with people, their families, CCS agencies, and providers. 
Behavior Support Services and the Mandt System
The DDA is dedicated to working with our stakeholders in the transition implementation from Behavior Principles and Strategies (BPS) to the Mandt System ® over the next two years.  A list of Frequently Asked Questions (FAQs) was sent out via email on Aug. 21, 2018. Another email will be sent out within the next few weeks giving additional guidance regarding the implementation of the Mandt System. If you have any questions or need additional information, please contact the DDA Director of Clinical Services, Dr. Meg DePasquale at
Maryland Department of Health
201 W. Preston St. | Baltimore MD, 21201
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