Check-In: The Oregon Needs Assessment and Service Hours

As you have heard from us before, the Oregon Needs Assessment (ONA) is currently being rolled out across the service system. By now, you should have received an ONA assessment from one of the new ONA Assessors located in case management agencies across Oregon. As a part of that process, you were probably told that the assessment is not yet tied to the allocation of services, which still happens through other means. But, when will that change, and what will the impact be on your services? Read on for an update on everything we know, to date.

If you qualify for Developmental Disabilities Services, there was likely a time in which you heard about services that might be available, and wondered, 'what does that really mean for me?' At its most basic, Developmental Disability Services are intended to meet the needs you have in your life due to a diagnosed developmental disability that are not being met by the people and resources around you. Oregon has developed one single assessment tool, the Oregon Needs Assessment, to gather information about your needs, assure that you qualify for care, and turn your answers into an allocation of service hours you may use to meet your needs. When the project is complete, the ONA will result in a Service Group Level, with a range of direct service hours that can be used to meet the needs you've identified. You can read more here about this phase of the project from the Office of Developmental Disabilities Services.

Let's run through the basics of this allocation process:

Who will this affect?

Everyone who qualifies for developmental disability services in Oregon who chooses to receive services from the Community First Choice (K) Plan will have an ONA, which will determine their Service Group Level, or how many hours they can use in the creation of their individualized service plan.

What will this mean for me?

For people in Brokerages, or receiving in-home services from a Community Developmental Disability Program, that grouping will translate to a range of hours that can be used for direct services. At this point, there has not been a final decision on what specific scores will yield, in terms of hours. It is possible that the hours for which you are eligible could go up or down. The hope is that, for most people, the hours they are using will fall within the Service Group Level for which they qualify. For people in 24-hour residential services, the result will be a rate paid to the provider for these services.

When can I expect to see this change happen?

This is a long and complex project that stands to affect the lives of many Oregonians. As such, the people involved have been careful not to rush the necessary steps. The latest communications from the state indicate that the Service Group allocations will begin to be implemented with the Residential Services rates in July of 2020. These new rate allocations will be will go into effect at one point in time for everyone using these services in the system.

For Brokerage and other in-home services, the new allocations are currently slated to begin rolling in sometime during the second half of 2020. The changeover to the new allocation for Brokerage and other in-home services will happen for individuals as their ISPs renew.

Why are we changing things?

This is a project that has been in the works for years now, in an effort to create the most accurate and user-friendly needs assessment possible. Part of the intent was to replace and consolidate several older tools used to assess and verify needs, including the Adult Needs Assessment (ANA). The ANA is the current source of hours allocation for people receiving in-home services.

The hourly allocations that rolled out in Oregon in 2013 with the advent of the Community First Choice (K) Plan were created quickly, with a very short deadline looming from the federal Centers for Medicare and Medicaid Services. There was not time to gather and consult a lot of data, or have the allocation algorithms tested and validated against real-life situations. Very shortly after they were created, there was discussion from within the developmental disabilities advocate community that called for a more detailed and scientific analysis of appropriate allocations. That is exactly what the Human Services Research Institute (HSRI) was hired to accomplish with this project.

How is HSRI figuring out how many hours people should receive based on their ONA answers?

HSRI's work has been complicated, and we are not experts, but I will do my best to share what we have seen as stakeholders. In summary, HSRI staff have taken the completed ONAs generated by all of the case management entities from across the state, and they have analyzed the results in detail. Based on what they saw, they did some preliminary groupings for allocation, trying to place people with similar needs in the same category. They pulled together a group of case managers and advocates to take a look at this preliminary work and see what it would mean for a sampling of actual people using the system. They took that feedback and made more refinements to try to get even closer to the goal of like people being sorted into the same grouping. Once that was done, they began to look at the hours currently utilized, and the needs expressed, by the people in the groupings. They took that data, crunched it, and came up with a range of hours for each group. HSRI is and will continue to go through many more steps to test the validity of those hour ranges before they are finalized.

This update is intended to help you understand this process as fully as possible, and we hope it has been useful. These changes are a big deal for people using DD services in their homes and communities, and we know that it can be unsettling to hear that you might have to make adjustments to your services. Our next blogpost in this series will focus on what we know about the exceptions process, and other ways to diversify your supports in order to weather these changes safely.