DHHS Internet Website - Developmental Disabilities

The Division of Developmental Disabilities is responsible to ensure maximum quality of services are provided to people with developmental disabilities throughout the state.

 

The Division has implemented standards to ensure quality services through Title 404 of the Nebraska Administrative Code, and it is also responsible to comply with the stringent terms and assurances required by the Centers for Medicare and Medicaid in Nebraska’s Home and Community Based Services, Developmental Disability Waivers.

 

This is primarily accomplished through the Division’s Quality Assurance/Quality Improvement section.

 

The Division’s Quality Assurance/Quality Improvement Section is comprised of three areas: Waiver Management, Survey and Certification, and Technical Assistance.

The Division’s Waiver Manager and team consists of two staff assistants, a contract coordinator, and twelve disability services specialists (DSS) that are physically located in local offices throughout the state.

With minimal technical assistance provided by the Centers for Medicare and Medicaid Services, the Manager was able to craft Nebraska’s current HCBS Waivers that meet, and in many ways exceed, national standards for person-centered practices and that emphasize true community integration and employment opportunities.

 

In the past years, the Manager has also taken over management of the DSS (which were recently managed by DD Service Coordination Districts, and prior to 2009 were under the Division of Children and Family Services), and provided them with significant training and oversight to equip them with the skills necessary to ensure compliance with CMS’s increasing quality assurance requirements.

 

The Waiver Management team has also recently taken over responsibility for developmental disability eligibility determinations. The individuals, families and other stakeholders have provided much positive feedback about this realignment of the eligibility process.

 

The DSS have received enhanced training on eligibility requirements and processes, and they have access to a DD Division staff psychologist when such expertise is required.

 

Eligibility determinations are significant for the Division, because our federal funding is contingent on valid and well-documented eligibility determinations.

 

Ensuring waiver compliance is crucial to the Division’s success, as almost 60% of our funding for developmental disability services is reliant on this compliance.

 

It is also important that the Division continue to meet routinely with individuals, families and community stakeholders to ensure that the service array provided by our current waivers continues to meet the needs of the people we support.

 

The Waiver Management team will lead the effort in ensuring waiver compliance and assessing community needs.

 

In October 2010, the Division assumed all certification activities for Specialized Providers. The 6 surveyor positions funded by the Legislature for increased community oversight were then transferred to the Division of Developmental Disabilities from the Division of Public Health.

 

The Survey and Certification team is now comprised of 9 surveyors that are located in Lincoln, Omaha, and Hastings.

The Surveyors focus on certification activities which include: on-site certification reviews, complaint review and investigations, analysis of reported incidents, and service reviews of provider services.

 

The Survey and Certification team has been provided with significant training to equip them to address the needs of the people served in the DD system.

 

Labor Relations Alternatives, Inc. has provided them with training in “Conducting Serious Incident Investigations” and every surveyor is required to be certified as a Level I Investigator.

 

The Council on Quality Leadership has trained the team generally on outcome based programming and person-centered practices, and has also provided the team with a four day assessment workshop on evaluation/monitoring of outcome based services. Dr. Michael Neise and Scott Fouts (Paradigm, Inc.) provided the team training on the development and assessment of functional behavior assessment, behavioral support plans, and safety plans.

 

Through H&W Consulting, the team was able to work with Catherine Hayes (a prior branch chief over survey and certification for the Centers for Medicare and Medicaid Services) to develop survey and certification processes and strategies and to receive further training on thorough investigations strategies.

The BSDC medical/professional team has also provided training on the identification of particular medical needs and proper medical supports for individuals in a community setting. Future training needs for the team will continue to be assessed annually.

 

The Division has worked hard to address these concerns and to ensure that individuals, families, and community stakeholders can be confident in the quality of services being provided by the Division. Much progress has been accomplished in this area, but the Division will remain diligent to ensure consistency in the survey and certification activities.

 

With the assumption of certification activities by the Survey and Certification team, the development of new waiver services, and revision of the Division's regulations, we recognized the importance of providing technical assistance to community providers separate and apart from the survey process; thus, the Technical Assistance team was created in 2009.

 

The technical assistance team consists of one psychologist, and one program specialist. 

 

Technical assistance services occur by phone, email, in-person, or via formal meetings or training opportunities.

 

In addition to general technical assistance, the Technical Assistance team processes and assists with the referrals for Team Behavioral Consultation (TBC), which is a service available to teams working with individuals who are experiencing challenging behaviors.

 

The Division currently contracts with OMNI Behavioral Health to provide TBC. TBC services are assessed on a quarterly basis.

 

The Technical Assistance team also prepares, conducts, and/or organizes DDD sponsored trainings statewide. These have consisted of: objective assessment process training; service coordination supervisor IPP review; a quarterly seminar series; planning with personal outcomes; eligibility determination training; Scales of Independent Behavior – Revised (SIB-R); and adult protective service reporter training by DHHS Children and Family Services Division.

 

The Technical Assistance team participates in training alongside other Division staff, so that they are equipped to share information and skills gained with providers, individuals in services and their families and other stakeholders.

 

They also make a diligent effort to provide competency tools, record Division training sessions and retain training documentation, so that training materials can be shared with others.

 

The Technical Assistance team is a key component of ensuring the continuity of quality services across Nebraska.

 

It is not feasible for local providers to have independent access to all areas of expertise in the developmental disability field, and it is quite difficult to stay on top of evolving national best practices. The Technical Assistance team helps bridge this gap for community providers.

 

Being independent from the Survey and Certification team is also helpful, as providers are sometimes hesitant to seek advice from staff that are responsible for regulatory activities.

The Division has been pleased with the progress made by the Technical Assistance team.

 

The team’s activities will be reviewed on an annual basis, and ongoing discussions will be held with individuals and their families, providers, and other community stakeholders to assess areas of need.