Direct Support Professional
Credential Design
NYSACRA 12th Annual Leadership Conference
Saratoga Springs, NY
12.4.14
The state in which people with IDD live is the biggest predictor of outcome,
the organization and factors such as turnover and culture are next
CONTEXT AND BACKGROUND
OF DSP WORK
Residence Size & Type -- June 30, 2012
New York
United States
Changes in the number of people with
IDD living in individualized settings
2000 to 2012
New York
United States
Estimated number of Medicaid LTSS recipients
with IDD by funding authority 2006-2012
New York
United States
Quality IS about and IS achieved through competent and reliable DSPs
DSP
WORKFORCE/PROFESSION
Competent direct support workforce
DSP expectations
Specialized knowledge
Culturally competent
Work well with others
Person-centered
End shift neat & tidy
Teach
Medical Support
Comply with rules
and regs.
Maintain health &
safety
Respect rights
Support Choice
Problem-solve
Document
State of Direct Support
No IDD specific data
Note: 23% are foreign born
Sustained DSP workforce
challenges (30 years)
•
•
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High Turnover / Low wages
Poor access to and utilization of benefits
Limited access to training and education
Increasingly absent or ineffective supervision
Status and Image
Sustaining “As Is” is costly
• Quality
• $$$$
25+ years, things are improving…
Positive Change
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Occupational Title = DSP
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Credentialing options exist
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Excellent tools available
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Status and Image
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Recognition
Codified core competencies
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Growing evidence base
DSPs + FLSs
Policy
CMS letter to states/toolkit
CMS minimal data set
DSP competencies
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CSSS
1996
Hewitt
1998
Community Support Skill Standards
NADSP Competencies
DOL LTSS Core Competencies
NY OPWDD Core Competencies
CMS Core Competencies
NADSP
Est 2002
DOL LTSS
2012
2013 NY
OPWDD
CMS DSW
2014
BUT.. These challenges remain
Remaining Challenges
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Challenging demographic changes
Wages are worse when adjusted for
inflation
Turnover remains challenging
Vacancies and growth stagnation continue
Little to no real penetration of post
secondary
Pervasive lack of IDD data
NY Direct Support Professional (DSP)
Credentialing Study
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Conducted by Research and Training Center
on Community Living at UMN
In partnership with NYSACRA and NYSRA
Funded by OPWDD
At the conclusion of the 2014 New York legislative
assembly a commitment was made to better
understand the programmatic and financial
implications of implementing a pilot of a robust
credentialing program in the state of New York.
Legislative language
No later than January 1, 2016 (which really
means July/August 2015) OPWDD shall issue a
report to the Governor, the temporary president of
the Senate and the Speaker of the Assembly
setting forth recommendations for the
establishment of a direct support professional
credentialing pilot program. Recommendations for
the program shall be based on a study to be
conducted by the Office for people with
developmental Disabilities and shall include
consideration of:
Continued…
1.National
and international models of direct support
credentialing,
2.Career ladders for direct support professionals and
supervisors
3.Current direct support professional salaries and
training requirements,
4.Classroom and on-the-job training requirements for
existing direct support credentialing programs and the
impact of these requirements on operations of
providers of service,
5.On-going and continuing education requirements for
credentialed direct support professionals,
6.Fiscal impact of a credentialing pilot program
7.Financial incentives for those that complete the
credentialing program” (AB 9205).
Key credentialing project activities
1.
Review and environmental scan

2.
Facilitate stakeholder engagement

3.
5.
6.
Advisory committee
Regional focus groups

4.
Contemporary human service credentialing and
apprenticeship models
DSP, employers, families, self-advocates
Financial model that builds training into Medicaid
reimbursement
Communication Plan
DSP training and credentialing provider survey
Conduct a Literature Review and Environmental Scan of Contemporary
Credentialing and Apprenticeship Models in Human Service Sectors
LITERATURE REVIEW AND
ENVIRONMENTAL SCAN (UMN - 2/28)
DSP career paths
Ladder
Lattice
Facilitate a Stakeholder Engagement Process to Guide Credentialing
Feasibility and Recommended Implementation Process (Advisory
Committee)
STAKEHOLDER
ENGAGEMENT - (NYSACRA - THROUGHOUT)
Advisory Committee Roles
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Review and approve provider DSP survey
Identify constraints and opportunities in NY with
regard to various credentialing models
 review and evaluate pros/cons of existing
credentialing models
Review, discuss and identify implications of focus
group findings
Discuss and recommend credentialing model and
CMS framework
Develop implementation and sustainability
strategies in collaboration with stakeholders that
promote regional buy-in
Conduct Regional Focus Groups with DSPs and Employers Regarding NY
DSP Credentialing program Implementation
Focus groups – (UMN- 4/30)
Regional focus groups
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Participants
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DSPs, FLS, Executive Director, Family, SelfAdvocate
Inclusive of public and private sectors
Questions
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Potential Benefits of Credential Program for
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Service Recipients & Families
DSPs
Employers
How to support DSPs? Barriers?
Structure of Educational/Training Program
Realistic, Accessible & Person-Centered
Create a Financial Model that Builds the Training Costs Into Medicaid
Reimbursement Rates
Financial Model – (UMN - 5/30)
Inclusion of Training Costs in Rate Setting
--July 13, 2011 CMS Bulletin
 Costs associated with requirements that are prerequisite
to being a qualified Medicaid provider are not
reimbursable by Medicaid.
 Costs associated with maintaining status as a qualified
provider may be included in determining the rate for
services.
 A State may require a provider to acquire continuing
education (CE) each period and may recognize such CE
expenses as a cost to the provider of doing business and
may consider such costs in developing the rate paid for
the service.
July 13, 2011 CMS Bulletin: Inclusion of
Training Costs in Rate Development
A State may wish to promote advanced provider
skills training to increase the availability of
providers qualified to serve beneficiaries with more
complicated or difficult medical needs.
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These costs could also be included in the development
of rates paid for services requiring more complex levels
of care.
A State could set provider qualification requirements at
a separate and distinct level for those advanced level
providers, and pay rates commensurate with their
higher skill levels. The qualifications and rates could be
higher than those for services furnished by less skilled
individuals.
Building Training Costs into Medicaid
Reimbursement Rates
Coverage of Direct Service Workforce Continuing Education
and Training within Medicaid Policy and Rate Setting:
A Toolkit for State Medicaid Agencies
Submitted by:
National Direct Service Workforce Resource Center
http://www.dswresourcecenter.org/tiki-index.php?page=reports
33
Create a Comprehensive Credentialing Program Implementation
Communication Plan and Related Tools
Communication plan – (5/30)
Data and stories
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Irrespective of the outcome there will be
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Useful ammunition for your advocacy
Important next steps identified
Model to implement here
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And elsewhere
Meet legislative requirement
Develop, implement and analyze a DSP Training and Credentialing
Provider Survey to Obtain a Baseline of Critical Workforce Indicators
PROVIDER SURVEY - (UMN - 4/30)
Need for provider survey
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Staffing ratios
Size, scope and demographics of
workforce
Wages and other costs data will inform
credential costs and financial model
Vacancies and turnover also factor into
costs and feasibility of credentialing
Regional differences
Current practices
Sample
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Providers who submitted CRF
Statewide
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Not limited to NYSACRA and NYSRA
members
Random sample N= 305
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Regional differences
95% confidence interval
Survey distribution plan
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NYSACRA will send an e-mail alerting provider
one week before launch
Within one week Qualtrics (UMN on-line survey
program) will send survey to provider with
greeting
NYSACRA will send follow up e-mail to
providers to be sure they received survey link
and if not to check SPAM
January Q&A session
One last follow up before close of survey
Look for this
*****SPAM*****
Inbox
x
Scott Spreat <sspreat@gmail.com>
Attachments3:03 PM (1 hour ago)
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Attachments area
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101014.docx
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wage study data collection 101014.docx
Who should complete this
survey?
Organizational profile
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Region
Size and scope of organization
Staffing
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# of employees
 DSP
 FLS
 Admin/other
Demographics of employees
 Education
 PT/FT
Wages
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Starting, average, highest
DSP and FLS
Benefits
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Sick
Vacation
PTO
FT/PT status for eligibility
Expenditures
Insurance
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ACA implications
Take up/utilization
Costs
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Org/employee
Retention
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DSPs and FLS Challenges
Crude separation
Vacancies
Reasons for turnover
Interventions used
Recruitment
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DSP/FLS
Extent to which a problem
Sources
Motivations to work for organization
Effective strategies
Advertising costs
Staffing practices
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OT
Use of temporary workers
Challenges due to short staffing
Training, career enhancement and
credentialing activities
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Organizational revenue
Training budget
DSP career enhancement activities
DSP training in org
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# hours
Adequacy
Credentialing (assumptions are provided)
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Incentives
Support
Predicted participation
Finance, provider costs and public
payment policies
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% revenue spent on DSP/FLS/admin
wage costs
Non reimbursed services
Wage increases
Increased costs to organization
Concerns and recommendations for rate
setting processes
Funding and Disclosure
Statement
Preparation of this presentation was supported, in part, by
a cooperative agreement from the Administration on
Intellectual and Developmental Disabilities, Administration
for Children and Families, U.S. Department of Health and
Human Services and a grant (#H133B080005) from the
National Institute on Disability and Rehabilitation Research
(NIDRR). Grantees undertaking projects under
government sponsorship are encouraged to express freely
their findings and conclusions. Points of view or opinions
do not, therefore necessarily represent official AIDD or
NIDRR policy.
Contact Information
Amy Hewitt, Ph.D.
612.625.1098
hewit005@umn.edu
Lori Sedlezky, MSW
612.624.7668
sedl0003@umn.edu
Research and Training Center on Community Living
Institute on Community Integration (UCEDD)
University of Minnesota, Twin Cities
214 Pattee Hall, 150 Pillsbury Drive SE
Minneapolis, MN 55455
This research was supported by grant from the National Institute on Disabilities and Rehabilitation Research, U.S.
Department of Education #H133G080029 and #H133B080005. Grantees undertaking projects under government
sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not,
therefore necessarily represent official NIDRR policy.