K Plan: Change is Coming to Oregon DD Services

Heretofore, Developmental Disability services have been provided under the Title XIX (Title 19) Medicaid Waiver, and have worked well enough. However, the system has not been without its faults. Over the last several months, the State of Oregon Department of Human Services (DHS) has been working on implementing a new funding and service delivery model: Community First Choice Option or “K Plan“. The State has said that it will increase both the overall amount of funding provided by Medicaid for disability-related service delivery in Oregon and the flexibility of service delivery, thus offering consumers additional choice in how and where their services are provided.

The State’s new Plan was approved by the Centers for Medicare & Medicaid Services (CMS) in July, and the State has been hard at work trying to hammer out the finer details of the actual implementation. In many ways this is an overhaul of the funding and service delivery model. But, the hope is that services will continue with as little disruption as possible.

DHS has released a transmittal outlining the K Plan Implementation and Transition Plan.

Recently, Larry Deal (Executive Director of Independence Northwest) has tried to summarize and clarify a few changes that may be coming as part of the transition to K Plan.

See Larry’s blog posts: Big Changes in Oregon’s I/DD Service System: Part One — The Functional Needs Assessment Tool, Part Two: Payment to Legal Guardians.

There has, however, been some concern in the community over the CMS rules (specifically, 42 CFR 441.555(c)(1-5)) designed to mitigate Conflicts of Interest when completing the Functional Needs Assessment Tool and the Person Centered Service Plan development process. Under these rules, as currently interpreted by CMS / DHS, Legal Guardian(s) of the service recipient cannot also be their direct service providers. As such, Oregon’s Office on Developmental Disability Services director Patrice Botsford issued a statement explaining the repercussions of this change:

“Families must make a decision whether the guardian will remain in place and not continue as the paid service provider and a new service provider chosen, or the guardianship may be terminated or transferred … We are asking that their decision be relayed to us via their case manager no later than December 1, 2013 for January 1, 2014 implementation.”

Needless to say, this change may have a large impact on Legal Guardians who are the heads of small households and/or in rural areas where there may not be another individual available to provide the specific services required or to take over the burden of Legal Guardianship. The Oregonian and the Lund Report have reported on the potentially negative impact of this change for some families.

A number of people and interested parties have begun to voice opposition this change. Representative Sara Gelser has put out a request on her Facebook page for how this change may impact you & those you know or provide services to. SEIU Local 503 has put out a similar inquiry.

SDRI will also be hosting a Self-Advocates and Parents Meeting with ODDS Director Patrice Botsford on August 22, 2013 from 6 PM to 8 PM to discuss various upcoming changes to DD services in Oregon (see our flyer for specifics on date, time, location & how to RSVP).

Lastly, again from Larry Deal at INW:

At present, ODDS is developing an exception policy that will potentially allow for some guardians to be paid under the K Plan. The exception policy is still in draft format and will be reviewed by CMS in the next week or so.

Advocates throughout the system continue to comb through federal regulations and state law to see if there are other approaches that can be taken to address the situation.

In the meantime, if you would like to be involved in the discussion and share your story, you have a few options.

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