Developmental Services

Developmental Services Option

  • The State of Vermont would award up to two statewide contracts to deliver case management  for the Developmental Services (DS) program. Case management organization(s) would apply through a state-run competitive process.  

    Current Designated Agencies (DAs) and Specialized Service Agencies (SSAs) would no longer deliver DS case management.      

    The current state designations for delivery of direct home and community-based services (HCBS) for people with intellectual or developmental disabilities remains the same, except for case management.  

    • These changes would allow DAs and SSAs to continue providing direct services for people eligible for Developmental Services. 
    • There will be changes to case management services, but very few changes to direct home and community-based services. 
    • Case management providers would not be the same organizations as the providers delivering direct services, so there would not be any conflict of interest.  
    • People seeking services would have a simple system to choose a case management provider and to access HCBS.  
    • One to two case management organizations for the whole state could help to make sure everyone gets the same high quality case management services.
    • Existing providers could think about ways to work together. They could develop new statewide organization(s) to apply for the contracts, as long as the new organizations are free of conflicts.*

    * Federal conflict of interest standards are available here.
    Conflict of interest requirements are described in plain language here when you click on “What does Conflict-Free Case Management require?”

  • ProsCons
    • There would be no conflict of interest. This option meets federal requirements.
    • An independent case manager would offer and support choices. They would help address problems/concerns with services and supports.
    • If two contracts are awarded, people will be able to choose from different case management organizations.
    • People would be able to easily understand the simple system for choosing a case management provider and getting services.
    • Having only one or two case management organizations would offer more consistency and equity for people across the state.
    • A process where case management organizations compete for the contracts may help the organizations be more creative, sharing new ideas and better ways to do things.
    • Competitive contracts can help the state to make sure the case management providers do a good job and offer quality services.
    • Independent statewide case management provider(s) may be able to help with other important system functions including training, data management and reporting, and information technology systems.
    • People will need to be supported to understand the changes in the system and the new roles and responsibilities of case managers and providers. They may need to develop new relationships with different providers.
    • Changes in the case management structure will be hard. This will be a big change in the current home and community-based services delivery system for Developmental Services. It may disrupt things for some people and some providers.
    • There are not very many local Vermont organizations who may be ready and able to become a statewide case management provider.
    • A process where providers apply to the state and compete for the contracts (competitive procurement) takes time. There is a short timeline to meet the federal corrective action plan requirements. Pre-competition processes to learn about provider interest, understand stakeholder priorities, and to receive and accept feedback, will be limited.
    • The state role will change to manage competitive contract activities and oversight of case management. This may require some new staff or staff with some different skills.
  • This table helps explain who would do different activities under this option. The six functions listed across the top are key HCBS activities related to case management.

    Roles:Eligibility and EnrollmentNeeds AssessmentPerson-Centered PlanningReferral and LinkingService/ Resource ApprovalService Monitoring & Ongoing Coordination
    StateApprove financial and clinical eligibility/ renewals

    (State approves people to get services)
    Maintain records

    Quality and compliance oversight

    (State keeps track of information about people’s needs. They make sure needs are getting assessed when they are supposed to)
    Quality and compliance oversight

    (State makes sure case managers are doing good person-centered planning)
    Quality and compliance oversight

    (State makes sure case managers are supporting access to services and choice)
    Approve DS service plans

    Oversee utilization management

    (State approves service plans. State makes sure services are aligned with needs)
    Quality and compliance oversight

    (State makes sure case managers are doing a good job)
    DA/SSARefer people to contracted case management entities

    (DA/SSAs tell people where to go to apply for services)
    Contribute information and data, observed risks and needs

    Assessment when part of direct service (for example, functional behavior assessment as part of Positive Behavior Support Services)

    (DA/SSAs share what they know about the person. They may do certain assessments when it is part of a service)
    As preferred by the person, participate as a contributor to the development of ideas, strategies and approaches to inform the plan

    (If a person wants providers to be part of their person-centered planning, the DA/SSA can be included)
    Coordination as part of direct HCBS

    (DA/SSAs do some coordination as part of a direct service)
    N/ASupport/track progress to goals

    Communicate with case management and support team about changes, problems, needs

    Manage day-to-day coordination tasks as part of HCBS delivery

    (DA/SSAs document how services are helping people. They work with case management to solve problems. They do some coordination as part of direct service)
    Contracted case mgmt. entityCoordinate/ complete eligibility assessments and intake paperwork for submission to AHS for approval

    (Case managers help people apply for services)
    Gather data and information, documents the person’s needs

    Conducts (or contracts) standard functional needs assessments (for example, Supports Intensity Scale, known as the SIS-A)

    (Case managers collect information about the person’s needs. They use standard tools to help understand needs, like the Supports Intensity Scale, called the SIS-A)
    Facilitate discovery, identify what is important to and for the person

    Identify goals and strategies

    Develop service and support plan

    (Case managers help people make decisions about their goals and how to meet them. They help the person choose their services and supports and who will provide them. They develop the plan)
    Offer unbiased choices in services, supports and available resources

    Assist with access to services, enrolling with providers

    (Case managers help people understand choices about providers and supports. They help the person connect to providers and resources that are helpful to meet the person’s needs and goals)
    Submit service plans to state for approval

    (Case managers send plans to the State for approval)
    Ensure people are receiving services as needed and as planned

    Monitor progress

    Manage ongoing coordination

    (Case managers check in with the person regularly. They make sure things are going well and help solve problems when they are not. They bring teams together when needed to make things work better or make changes)

    *Note: The bolded areas in each section are plain language explanations of the function.

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