STANLEY LIGAS, et al. v. JULIE HAMOS, et al. The LIGAS Experience – 30 Months Later

1. February 6, 2014 Tony Records Monitor traconsult@mindspring.com STANLEY LIGAS, et al. v. JULIE HAMOS, et al.The LIGAS Experience – 30 Months Later

2. We Are Working Together To Make Ligas Work for Class Members

3. Principles of Ligas People with disabilities will have a say and a choice about how and where services and supports will be provided. People who want services in the community will have that option Person-centered planning will be used as the cornerstone in documenting individual needs and preferences. Services will not be limited to those which are currently available

4. Overall Activities of the Defendants and Progress • Ligas Implementation Team Established • Ligas Budget Developed • Ligas Website Established and Updated • Significant Progress on Class Member List • Over 3,000 Ligas Class Members Have Been Funded for Services • Ligas Transition Service Plan Developed and is Now Underway • Outreach Activities are Underway

5. Resources and Capacity • Ligas Budget Developed • FY 14 $34.8 Million for Ligas Implementation • $220 Million Additional to Address Payment Cycle Problem • Recent Rates Adjustments • Increase in Benefits for Staff • Slight Modifications to Address Rate Disincentives for Smaller (1-4 Person) Homes • New Ligas Team Members Hired • Enhancements for PAS Agency Reimbursement • Waiver Amendments for Expansion Approved

6. Resources and Capacity (Cont.) • Some Progress, But Much To Be Done! • 17 of 18 Ligas Implementation Team Members Hired • Overall, DDD Seriously Understaffed • Rates Still Among Lowest in the Country • Budget for Consultants and Contractors Has Been Utilized • Rates for Smaller Settings are Still Problematic • Resources for Employment Option Still Wanting

7. Class Member List • Two Class Lists • ¶2 (a) ICF/DD Class Members • Current Total 935 Class Members • List Established and Documentation Maintained • List Has Improved Over Time • ¶2 (b) Waiting List Class Members • Current Total 13,403 (as of 10/1/13) • Accuracy of PUNS List Data Improving • Inaccuracies Have Affected Funding Selection Process • Highlights the Need for Comprehensive Data System

8. Transition Services Plans • Defendants Developed Transition Plan Documents Through Stakeholder Involvement • Pilot Completed • Suburban Access & DDSME • Implementation Started September 2012 • Sample Size 141 • Final Version on DDD Website • Statewide Rollout on July 1, 2013 • Transition Planning Consultant is reviewing Working with PAS Agencies • PAS Agency Training Completed

9. Transition for Class Members in ICFs/DD • 935 Class Members in This Category • 620 Have Received Funding Approval • 578 Have Actually Started Services (8 in Home Based) • 121 Individuals Have Changed Their Mind and Chosen to Stay • Updates on Remainder of Class Members are Obtained Monthly • Voluntary Downsizing and Closure Agreement have and will Continue to have Significant Impact on this List (321 class members) • Non-Compliance for St. Mary’s Square Activities

10. Crisis Services • Notification of Non-Compliance, May 1, 2012 • Corrective Action Plan Developed, with Input from Class Counsel. Includes: • Internal Quality Assurance Controls • Streamlined Processing Steps • Adjustments to Data-Base • Changes Review Meeting Structure • Authorization for Network Coordinators to Issue Pre-Award Letters • Training of Network Staff and PAS Agencies • Management Review will be Included In Data Reports Document • Second Compliance Review Found Substantial Improvement

11. Transition for Class Members on Waiting List Over 13,400 Class Members in This Category (1/1/14) • Four Selection Events (total of 3,606 class members) • Serious Flaws in List - Eliminated Nearly One third of Individuals from first two Selection Processes • Services Initiated for 1,540 Class members! • Funding Approved for Additional 106 Class Members • 31 Packets Have Been Submitted for Approval • 465 More Being Screened • 144 More Confirmed That They Want Community Services • Fourth Selection Letters Sent 9/23/13 (473 Letters) • Fifth Selection Event Will Be In Spring-2014

12. Transition for Class Members on Waiting List (Cont.) • Projections are that more than 1,600 class members will be served by June 30, 2014 – 100 more than required!! • Happened Due To DDD Aggressively Working with PAS Agencies to Expedite Processing • Clear Need to Expand Options!!!! • Employment and Meaningful Day Options • Smaller Residential Settings • Many Class Members and Families are Reluctant to Ask For What They Want!

13. Transition PlanParagraph 13 What does this really mean? The process for developing a Transition Service Plan shall focus on the Class Member’s personal vision, preferences, strengths and needs in home, community and work environments and shall reflect the value of supporting the Class Member with relationships, productive work, participation in community life, and personal decision-making.

14. Does Size Matter? • Of all Class Members who Moved to CILA, 66% moved to 7-8 person group homes. • 73% of class members who moved from an ICF/DD moved to 7-8 person group homes • Only 14% moved to settings of 1-4. This is Inconsistent with Current Practice For many class members, this was not their choice! Significant ICF/DD Closures on the Horizon

15. What Do The Transition Plans Show? • Over100 Transition Plans Were Reviewed • Some Class Members Were Not Directly Involved in the Plan Development • Most Plans Lacked Options for Daytime Activities • LSTP is Not Foundation fo Service Plans What About Employment? • Only 14 Plans Reflected any Discussion of Employment • Only Four Plans Included Supports for Employment • School Transition Plans Were not Considered

16. So What are We Telling Self-Advocates and Families? • Start thinking about what you need and what is important to you • What will keep you safe and healthy? • Where do You Want to Work • What will you do during the day? • Who do you want to live with? • Where do you want to live? • What are the most important things that will give you a happy and fulfilling life? • Who are the most important people in your life? • How will you make new friends in the community?

17. OUTREACH • Training Activities for PAS Agencies • Development and Refinement of Ligas Website • Outreach Contract • Awarded to Council on Quality and Leadership (CQL) • Protocol Has Been Developed • 3,400 Potential Class Members • Orientation for ICF/DD Providers on June 26, 2013 • Staff Hired and Have Begun Activities

18. Implementation Plan • Revisions Approved by Court on March 5, 2013 • Establishes Ligas Class Member/Family Advisory Group • Includes Update of Implementation Activities • Available on DDD Website

19. Data Reports • Most Recent Submission on August 15, 2013 for Data through June 30, 2013. • Includes Data on Services and Size of Community Residential Settings • On DDD Website

20. Dispute Resolution • Corrective Action Plan Developed to Include: • Hiring of 3 New Hearing Officers • New Hearing Officers Trained • Application Process is Being Streamlined • Rights Statement is Being Modified • PAS Agencies to be retrained on Submitting Appeals Request • Crisis Appeals to be Given Top Priority • Management Reports to Be Generated and Provided with Data Reports Submission

21. The Bottom Line • More than 3,000 Class Members Have Received Funding Approval for Services as a Direct Result of Ligas!! • People in Crisis are now being served in 24-72 hours • This is the Third Year of at Least a Nine-Year case! • Ligas Activities Have Exposed and Will Continue to Expose many Weaknesses in the System! • Making, Documanting and Honoring Choice Has Been Problematic!

22. Contact The Monitor Tony Records traconsult@mindspring.com 301-529-9510

23. Questions?