AAIDD Manual Intro€¦ · Georgia $2.7 billion 12.90% Oklahoma $114 million 1.70% Hawaii $232...
Transcript of AAIDD Manual Intro€¦ · Georgia $2.7 billion 12.90% Oklahoma $114 million 1.70% Hawaii $232...
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AMERICAN ASSOCIATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
501 3rd Street NW, Suite 200 • Washington, DC 20001 • 202-387-1968 • www.aaidd.org
©Copyright 2009 AAIDD
AAIDD
Presents
Developing Individual Budgets and Reimbursement Levels
Using the Supports Intensity Scale
Distinguished Faculty
Jon Fortune, Ed.D.
Senior Policy Specialist
Human Services Research Institute
John Agosta, Ph.D.
Vice President
Human Services Research Institute
Bruce Applegren (Moderator)
Director of Publications
American Association on Intellectual and Developmental Disabilities
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AMERICAN ASSOCIATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
501 3rd Street NW, Suite 200 • Washington, DC 20001 • 202-387-1968 • www.aaidd.org
©Copyright 2009 AAIDD
Thanks for participating in “Developing Individual Budgets and Reimbursement Levels Using the Supports Intensity Scale” on
Tuesday, June 30, 2009. This manual contains important information you’ll need to prepare for this conference.
YOUR CONFERENCE MANUAL
This manual contains:
• Instructions for accessing the conference
• Speaker bios and contact information
• Tips for submitting questions to speakers
CONFERENCE DETAILS
Your conference will be held Tuesday,
June 30, 2009 at 2:00 p.m. EDT, 1:00 p.m.
CDT, 12:00 p.m. MDT, and 11:00 a.m.
PDT. The conference will last 90 minutes.
If you are using a speakerphone, put the
phone on MUTE for the best sound quality.
HOW TO JOIN THE CONFERENCE
Audio
-Dial 1-866-686-6233 approximately 5-10
minutes before the start of the conference.
-Enter PIN 4798.
-You will hear music on hold until the
conference has started, or be connected
directly if it has already begun.
-- If you have trouble with your phone
access, stay on the line and an operator
will assist you.
If you are disconnected at any point during
the call, just call back and repeat the process.
Web
-Go to http://www.meetingmagnet.com/ws.
-Enter conference ID 4798.
-Leave access code blank.
-Enter name, company and e-mail.
-Click log on to join conference.
HOW TO SUBMIT QUESTIONS TO
PANELISTS
If you wish to submit a question to our
panelists, you may do so during the
conference by using the chat function at the
bottom of the web page (once you have
logged on). This option, as well as live
Q&A, will also be available during the
conference.
TIPS FOR ASKING QUESTIONS
You are on "listen only" mode unless you
choose to participate in the live Q&A. If
you are using a speakerphone, put the
phone on MUTE for the best sound quality.
If you want to ask a live question:
• Be sure to UNMUTE your phone before you
are called on so there is not a pause in the
conference, and so the moderator does not
pass you over for the next question.
• Lift the handset while asking your question
for best sound quality.
• Be sure there are no loud background noises
in the room while asking your question.
Should you have questions or concerns,
please call 800-424-3688.
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AMERICAN ASSOCIATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
501 3rd Street NW, Suite 200 • Washington, DC 20001 • 202-387-1968 • www.aaidd.org
©Copyright 2009 AAIDD
Speaker Bios and Contact Information
Jon Fortune, Ed. D., is a Senior Policy Specialist at HSRI. He received his doctorate from the University of Northern Colorado. Dr.
Fortune has solid research skills as well as hands-on experience as a state administrator. In 1990, he joined the Wyoming Department
of Health Developmental Disabilities Division where he has held senior management positions. He was instrumental in designing and
implementing Wyoming’s system of community services for people with developmental disabilities and acquired brain injury,
including developing Medicaid HCBS waivers for both populations. During his tenure in Wyoming, the state substantially reduced the
number of people served in its large state facility and built an especially strong system of quality community supports. Dr. Fortune
was also the chief architect of the precedent-setting Wyoming DOORS model through which people with disabilities are assigned
individual budgets based on their assessed needs and other factors. Prior to joining the Wyoming Department of Health, Dr. Fortune
managed a community agency in Wyoming and held other positions in Colorado and Illinois and is working on financial architecture
in DD statewide services systems in ten states.
CONTACT
Jon Fortune, ED.D.
Senior Policy Specialist
HSRI
7420 SW Bridgeport Road Suite 210
Portland, Oregon 97224
503-924-3783 X13
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AMERICAN ASSOCIATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
501 3rd Street NW, Suite 200 • Washington, DC 20001 • 202-387-1968 • www.aaidd.org
©Copyright 2009 AAIDD
John Agosta, Ph.D. is Vice President of HSRI. He completed his doctorate in Rehabilitation Research at the University of Oregon,
specializing in research methods and community supports for people with disabilities. Employed at HSRI since 1983, he has been
involved with nearly all efforts at HSRI surrounding family support issues, facilitated development of strategic plans, conducted
analyses of state systems for people with developmental disabilities (e.g., Arkansas, Florida, Illinois, Idaho, Oregon, Hawaii, and
Texas), and has studied specific facets of the field (e.g., trends in supported employment, managed care, self-determination). He is a
nationally recognized expert in topic areas such as family support, self-directed supports and community systems regarding policies
that affect individuals with developmental disabilities. He leads the project at HSRI called Sage Resources Person Centered Funding,
(www.sageresources.org). This effort concentrates on assessment informed person centered adult waiver reimbursement techniques.
CONTACT
John Agosta, Ph.D.
Vice President
HSRI
7420 SW Bridgeport Road Suite 210
Portland, Oregon 97224
503-924-3783, X11
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AMERICAN ASSOCIATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
501 3rd Street NW, Suite 200 • Washington, DC 20001 • 202-387-1968 • www.aaidd.org
©Copyright 2009 AAIDD
Bruce Appelgren (Moderator) is Director of Publications for the American Association on Intellectual and Developmental
Disabilities. He has published books, manuals, magazines, and commercial newsletters. He is cofounder and former associate
publisher of Health Affairs, the policy journal of the health sphere.
CONTACT
Bruce Appelgren
Director of Publications
AAIDD
501 3rd Street NW, Suite 200
Washington, DC 20001
202-387-1968
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McNichol & Lav, Center on Budget and Policy Priorities, 2008
Texas projects budget gaps in
FY2010
Total Shortfall $78 billion …
This was reported just after the
October economic downturn
4 Human Services Research Institute
State
Total Budget
Shortfall for
FY2009
Gap as Percent of
FY2009 General
Fund
State Total Budget Shortfall for
FY2009
Gap as Percent of
FY2009 General
Fund
Alabama $1.2 billion 15.00% Mississippi1 $114 million 2.20%
Arizona1 $3.1 billion 30.80% Missouri $342 million 3.80%
Arkansas $107 million 2.40% Nevada $1.4 billion 19.60%
California $30.6 billion 30.30% New Hampshire $250 million 8.00%
Colorado $99 million 1.30% New Jersey $3.7 billion 11.40%
Connecticut $542 million 3.20% New Mexico $253 million 4.20%
Delaware $369 million 10.10% New York $6.4 billion 11.40%
D.C. $227 million 3.60% North Carolina $800 million 3.70%
Florida $5.5 billion 21.50% Ohio $1.9 billion 6.80%
Georgia $2.7 billion 12.90% Oklahoma $114 million 1.70%
Hawaii $232 million 4.00% Oregon $142 million 2.10%
Idaho $131 million 4.40% Pennsylvania $565 million 2.00%
Illinois $3.8 billion 13.40% Rhode Island $802 million 24.50%
Iowa $350 million 5.50% South Carolina $804 million 11.70%
Kansas $137 million 2.10% South Dakota $27 million 2.20%
Kentucky $722 million 7.80% Tennessee $1.2 billion 10.40%
Maine $265 million 8.60% Utah $354 million 5.90%
Maryland $1.3 billion 8.80% Vermont $122 million 10.00%
Mass. $2.6 billion 9.20% Virginia $2.2 billion 12.80%
Michigan $472 million 4.80% Washington $413 million 2.70%
Minnesota $ 1.4 billion 7.90% Wisconsin $998 million 7.10%
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5 Human Services Research Institute
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7
Gary Smith, HSRI
Wait List
Increasing
Service Demand
Resources
Human Services Research Institute
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Group Homes Day Habilitation
Public Institutions
IEP, ISP, IHP, IWRP, IFSP, IPP Family
Support
Supported Work
Token
Economies
Supported
Living
1956... 1962... 1972 ... !976...1983... 1987.. .1992... 1997.. 2000... 2003…2008
Customized Employment
Apartments
Self-determination
Human Services Research Institute
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Work Force Shortages Are Real
He’s broke.
Must be a direct support worker…
9 Human Services Research Institute
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10 Human Services Research Institute
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11
Budget Shortfalls
Weighty Legacy Services & Structures
Workforce Shortages
Quality Problems
Rising Unmet Demand
Antiquated Technologies
Fragmentation
Human Services Research Institute
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12 Human Services Research Institute
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This is not the same system it was ten years ago!
13 Human Services Research Institute
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An action agenda anchored in values and
committed to making the changes
necessary to secure the best outcomes
possible for people with developmental
disabilities and families.
14 Human Services Research Institute
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15 Human Services Research Institute
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People with Developmental Disabilities
(1% of the populationV%
Big House State
Op ICF-MRs
Community
ICF-MRs
HCBS Waivers
Comprehensive &
Specialty Waivers
Supports
Waivers
State
Funded
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An Overall Look at Things
17 Human Services Research Institute
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18 Human Services Research Institute
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19 Human Services Research Institute
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20
Person-Centered Budget Allocations
Adjusted Service Reimbursement
Rates Human Services Research Institute
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21
Focus on Developing Resource Allocation Models
Human Services Research Institute
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# Set Levels & IBAs
$ Implement ! Prepare % Collect Data
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Compile the Collected
Information
Collect Information on
Individuals
Assign Individuals to
Assessment Levels
Set Individual Budget
Allocations in Relation to
Rates
Review Findings in Relation to Policy Goals
Consider Implementation
Issues
Set Policy Goals
Choose Assessment
Measure
Engage Stakeholders
Plan for Implementation
22
Implement New Practices Review
Provider Reimbursement
Human Services Research Institute
Reconcile Levels
and Rates
![Page 28: AAIDD Manual Intro€¦ · Georgia $2.7 billion 12.90% Oklahoma $114 million 1.70% Hawaii $232 million 4.00% Oregon $142 million 2.10% Idaho $131 million 4.40% Pennsylvania $565 million](https://reader033.fdocuments.net/reader033/viewer/2022042809/5f8ea08d9b7f2e18cb1c2226/html5/thumbnails/28.jpg)
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24 Human Services Research Institute
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26
1.:*3*36(!"#$%$#&'()
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Given that the field is moving toward individualized budgets, it is essential for policy makers to be precise in what is meant by an “individual budget allocation” (IBA).
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30
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34
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Budget Allocations Per Level
SIS Results
Individual Budget Levels
Reconcile Budgets & Rates
Proposed New Rate Structure
Cost Reviews Per Person and Service
Reconcile Budgets & Rates
Proposed New Rate Structure
Cost Reviews Per Person and Service
SIS Results
Individual Budgets
>$1'&D%&7)
H-P() H->()
Human Services Research Institute
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QA%(710&()70)B%)#&(L%4%,5(
35
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36
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37
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38
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39
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40
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41
What liability does the state face if it cannot fund
the individual budgets?
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42
Do these individual budget allocations or
individual budget levels ever need
adjustment?
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44 Human Services Research Institute
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47 Human Services Research Institute
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48
The Supports Intensity Scale (SIS) and how it is being used
Human Services Research Institute
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49 Human Services Research Institute
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50 Human Services Research Institute
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53 Human Services Research Institute
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55 Human Services Research Institute
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56 Human Services Research Institute
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Case Studies -- Working with States
Georgia
Colorado Oregon
Virginia Louisiana
57
If I am only for myself, who is for me?
And if I am only for myself, what am I?
And if not now, when?
Rabbi Hillel
Human Services Research Institute
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58
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Georgia Resource Allocation System November 2008
Human Services Research Institute
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59
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60
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61
Community Safety Risk Two Levels
6 Levels and 42 subgroups of Support Needs with Medical and Behavioral
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Levels Adult Residential
People in Sample
Type of Need
1 70 Milder Support Needs
2 49 Moderate Support Needs
3 51 Severe Support Needs (SN)
4 30 Severe SN with Moderate Behavior & Medical
5 63 Severe SN with More Serious Behavior & Moderate Medical with Community Safety 30%
6 56 Severe SN Extraordinary Medical and Behavioral with Community Safety 50%
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64 Human Services Research Institute
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Levels ABE Medical Problems
Behavioral Problems
Risk DD50 Staff Direct Hours
1 24 1 2 0 6
2 29 2 4 0 7
3 32 3 5 0 7
4 34 4 6 0 10
5 34 5 6 30% 12
6 35 7 9 50% 12
65 Human Services Research Institute
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66
The Colorado Comprehensive waiver six support levels
condense to four support (SLS) waiver caps or levels
Human Services Research Institute
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67
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68
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*Fortune, et.al. Colorado Supported Living (SLS) Waiver. (February 2009). HSRI. Portland, OR. Colorado will reexamine these levels and dollars in the spring of 2009 due to budget and economy restraints.&
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72 Human Services Research Institute
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73 Human Services Research Institute
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74 Human Services Research Institute
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75 Human Services Research Institute
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76 Human Services Research Institute
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78
Implement New Practices Review Provider
Reimbursement >&.)
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# Set Levels & IBAs
$ Implement ! Prepare % Collect Data
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Assessment Levels
Set Individual Budget
Allocations in Relation to
Rates
Review Findings in Relation to Policy Goals
Consider Implementation
Issues
Set Policy Goals
Choose Assessment
Measure
Engage Stakeholders
Plan for Implementation
Human Services Research Institute
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Human Services Research Institute 79
About HSRI and the Authors The Human Services Research Institute (HSRI) was founded in 1976 and is a non-profit, tax-exempt corporation with offices in Cambridge, Massachusetts and Portland, Oregon. For over 30 years, HSRI has assisted states and the federal government to enhance services and supports to improve the lives of vulnerable citizens, such as those with developmental disabilities or mental illness, or low income families. HSRI has provided consultation in such areas as strategic planning and organizational change,
funding, systems integration, quality management and assurance, program evaluation, evidence-based practices, family support, self-advocacy, self-determination, and workforce development. For more information, visit: www.hsri.org. This presentation was prepared by the following staff:
John Agosta, Ph.D., is an HSRI Vice President. He completed his doctorate in Rehabilitation Research at the University of Oregon, specializing in research methods and community supports for people with disabilities. Employed at HSRI since 1983, he has been
involved with nearly all efforts at HSRI surrounding family support issues, facilitated development of strategic plans, conducted analyses of state systems for people with developmental disabilities (e.g., Arkansas, Florida, Illinois, Idaho, Oregon, Hawaii, and Texas), and has studied specific facets of the field (e.g., trends in supported employment, managed care, self-determination). He is a nationally recognized expert in topic areas such as family support, self-directed supports and community systems regarding policies that affect individuals with developmental disabilities. He leads the project at HSRI called Sage Resources Person Centered
Funding, visit www.sageresources.org. This effort concentrates on assessment informed person centered adult waiver reimbursement techniques.
Karen J. Auerbach, Ph.D., is currently working as a Statistician and Senior Research Analyst on several developmental disabilities projects at HSRI, primarily on the National Core Indicators project and the Sage Resources Person Centered Funding project. Over the past twelve years she has developed her research, analytic, and data management skills on education and
substance use research projects at the Harvard Graduate School of Education, Boston College, the Education Development Center in Newton, MA, and at Pennsylvania State University. She has a Masters in Developmental and Educational Psychology from Boston College, and a Masters and Ph.D. in Human Development and Family Studies with a minor in Statistics from Penn State. She has worked on reimbursement in British Columbia, Colorado, Oregon, Rhode Island, and Virginia.
Jon Fortune, Ed. D., is a Senior Policy Specialist at HSRI. He received his doctorate from the University of Northern Colorado.
Dr. Fortune has solid research skills as well as hands on experience as a state administrator. In 1990, he joined the Wyoming Department of Health Developmental Disabilities Division where he has held senior management positions. He was instrumental in designing and implementing Wyoming’s system of community services for people with developmental disabilities and acquired brain injury, including developing Medicaid HCBS waivers for both populations. During his tenure in Wyoming, the state substantially reduced the number of people served in its large state facility and built an especially strong system of quality
community supports. Dr. Fortune was also the chief architect of the precedent-setting Wyoming DOORS model through which people with disabilities are assigned individual budgets based on their assessed needs and other factors. Prior to joining the Wyoming Department of Health, Dr. Fortune managed a community agency in Wyoming and held other positions in Colorado and Illinois and is currently working on financial architecture in DD statewide services systems in ten states.
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Human Services Research Institute 80
Madeleine Kimmich, D.S.W., a Senior Research Fellow in HSRI's Oregon office, currently co-directs the office and leads several projects in child welfare and in developmental disabilities. She received her doctorate in social welfare policy from the University of California-Berkeley. Dr. Kimmich has been engaged in evaluation research and policy analysis of human services
for over three decades. She has assisted decision-makers at federal, state, and local levels to work collaboratively with consumers and families to improve the effectiveness of programs targeted to low-income children and families, adolescents, the elderly, and people with disabilities. Dr. Kimmich currently leads an analysis of Oregon’s public sector efforts to address substance abuse. She also directs a 12-year evaluation of Ohio's Title IV-E Waiver Demonstration Project, which examines the impact of flexible but limited federal funds on local child welfare reform initiatives. She currently participates on HSRI’s team to
develop HCBS waiver reimbursement methodologies, and has contributed to the development of performance indicators for consumer-directed service approaches in developmental disabilities. As co-editor of Quality enhancement in developmental
disabilities: Challenges and opportunities in a changing world (2002) and as director of numerous state-level studies on quality management, Dr. Kimmich has maintained an active presence in the quality assurance and systems improvement arena, to increase efficiency and equity of service and support systems for all vulnerable populations.
Kerri Melda, M.S., is a Policy Associate at HSRI. She holds a Master’s Degree in Public Policy and Administration (University of Oregon) and a Bachelor’s Degree in Special Education (Indiana University). Ms. Melda has been employed with HSRI since 1992, and her primary responsibilities include project leadership, policy and statistical analyses, program evaluation, and provision of
training and technical assistance. Specifically, her work focuses on projects related to family support policy and practice, person-centered funding, performance gap analyses, and studies assessing the impact of change on service recipients. Ms. Melda currently serves as Director of HSRI’s Juntos Podemos (Together We Can) Family Center, connecting Latino families who have children with disabilities to community services and supports. She oversees the family support related activities of the National Core Indicators project, which analyzes family support satisfaction data across 30 states. She recently completed a study of the
impact of service reductions on Florida’s service population, and has worked on reimbursement projects in Colorado, Rhode Island, and Virginia.
Sarah Taub, M.M.H.S., is a Policy Associate at HSRI. She carries primary responsibility for managing the National Core Indicators (NCI), a collaborative effort of HSRI and NASDDDS that began in 1997 to develop indicators and benchmarks of performance across state developmental disabilities service systems. She also provides technical assistance under the CMS National
Contractor on Quality in HCBS Services and works on various projects related to program evaluation. She holds a Masters Degree from the Heller School at Brandeis University. She has worked on individual budgets in Colorado, Georgia, and Rhode Island.
Drew Smith, B.A., is a Policy Assistant at HSRI. He is a graduate of Portland State University in Business Administration, and currently works on several HSRI projects tied to: developing person-centered funding strategies, assessing the impacts of service changes and reductions, and supporting self-advocacy. He has worked on waiver reimbursement projects in Colorado,
Florida, Oregon, Rhode Island, and Virginia.