Important	Transition
Information 	Every
Family 	Should 	Know

Transition  Information
Fact Sheets

April 2015

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Transition Information Fact Sheets

Table of Contents

GETTING STARTED

r 1. Developing a Vision

r 2. Person-Centered Planning

r 3. Letter of Intent

r 4. Transition Timeline

r 5. Student’s Role in Transition

r 6. Family’s Role in Transition

r 7. Tips for Maximizing the Educational Process

TRANSITION ESSENTIALS

r 8. Federal and Massachusetts Laws on Transition

r 9. Chapter 688/Turning 22

r 10. DDS Adult Eligibility

r 11. Supports for Adults with Autism Spectrum Disorder

r 12. MASSCAP and Prioritization

r 13. Supports Intensity Scale (SIS)

r 14. Adult Services

r 15. Participant-Directed Supports Program

r 16. Agency With Choice  Program: Co-Directed Supports

r 17. Employment First Initiative

r 18. Transportation

r 19. Family Support, Recreation, and Friendships

r 20. State Agency Resources

r 21. Residential Alternatives

r 22. DDS Home  and Community-Based Waiver Overview

OTHER RESOURCES & CONSIDERATIONS

r 23. Age of Majority, Guardianship, and Alternatives

r 24. MassHealth Benefits

r 25. SSI Benefits

r 26. Special  Needs Trusts

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 1  • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Developing a Vision

A “Vision” for a young person’s future after high  school is based  on that person’s interests, aspirations and dreams.  It is helpful to start thinking and developing a realistic Vision  for the future during the teen years. Parents,  siblings, teachers, friends, and other interested parties can help and support the young person to develop a Vision.
It is important that goals, objectives, and strategies developed on the Individualized Education Program
(IEP) during later school years support the Vision.  The Vision  is a starting point and can be revised over  time.

Things to consider when developing a vision

List the person’s strengths, interests, and accomplishments.

COMMUNICATION
»  What is the person’s communication style?
»  How  does the person respond in social, familiar, and unfamiliar situations?
»  Does the person use technology or an assistive  device to communicate?
»  How  does the person respond to changes in routine?

HOME
»  Where will the person live?
»  With family, in shared  living,  with a housemate, in a house or apartment?
»  What would be the ideal living arrangement?
»  Would an urban,  suburban, or rural  setting be preferred?
»  Should  the environment be lively,  quiet,  or predictable?
»  What supports are needed and what resources are available?
»  Does the person use or need any equipment to be successful?
»  Do medical factors play an important role?

DAY
»  What does the person want to do after graduation?
»  Where does the person want to work?
»  What work schedule is possible?
»  What would an ideal day look  like?

COMMUNITY
»  What does the person like to do for fun?
»  Where,  with whom, and how  often will the person go to restaurants, hairdresser/barber, grocery store, library, clubs, parks, museums,  etc.?
»  What does the person do on weekends and other periods of free time?
»  What opportunities are there  to connect with the community through volunteering, clubs, gyms,  and other local activities?

TRANSPORTATION
»  How  will the person get  from place  to place?
»  Can the person walk, take the bus or public transportation, use ADA  transportation, ride with family or friends?

RELATIONSHIPS
»  Who  are the person’s friends?
»  What relationships could be strengthened?
»  Where will the person socialize and meet  new people?

These are just a few questions to get  started. The Vision  will be developed over  time  as more  questions about the future are asked and answered. When  beginning to implement the Vision,  the team should consider personal resources and networks, community opportunities, and public benefits in order to bring the Vision  to life.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 2 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Person-Centered Planning

What  is Person-Centered Planning?

Person-Centered Planning (PCP) is a process used to help people with disabilities create a vision  and a plan for the future based  upon  the person’s unique interests, hopes  and dreams.  A Person-Centered Plan is best done  prior to transition, as it can help to develop the transition plan, but  can be done  at any time  in a person’s life.
A PCP team must include the person and may also include parents/family members, teachers, peers, caregivers, and community members. Participants must be committed to taking action to make sure that the strategies and outcomes discussed in planning meetings are implemented. A trained PCP facilitator is typically identified to facilitate the process.
This team meets  regularly to identify opportunities for the person to develop relationships, participate in the community, increase  decision making, and develop the skills and abilities needed to achieve these goals.

THE FIRST STEP IN THE PLANNING  PROCESS: THE PERSONAL PROFILE
1.     Develop a history or personal life story of the person.  Things  such as background, critical events,  medical issues, major  developments, important relationships, etc., may be shared.
2.  Describe the quality of the person’s life, considering community participation, community presence, choices/rights, respect, and competence.
3.  Preferences of the person.  Things  the person enjoys  doing, as well as things they  do not  like at all.
The personal profile is best discussed prior to the PCP meeting so the participants have time  to reflect on what is shared. The meeting may use graphic symbols in place  of words to help stimulate creativity and encourage participation across all areas of life.

THE NEXT STEP: THE PLANNING  MEETING
1.     Identify a PCP facilitator and the “person-centered” team members.
2.  Review  the personal profile. Give the group the chance  to make additional comments and observations.
3.  Identify ongoing events  that are likely  to affect the person’s life.
4.  Share visions  for the future. Through brainstorming, participants are challenged to imagine ways to increase  opportunities.
5.  Identify obstacles and opportunities. Identify things that can make the vision  a reality.
6.  Identify strategies. Outline action steps for implementing the visions.
7.   Identify action steps that can be completed within a short  time  and who  is responsible.
8.  Identify the services  the person would benefit from.

FOR A PLAN TO BE SUCCESSFUL, IT IS BEST IF:
»  People  have a clear and shared  appreciation of the talents and capacities of the person.
»  People  have a common understanding of what the person wants.
»  The group agrees  to meet  regularly to review activities.
»  The group includes a strong advocate or family member, ensuring that the interests of the person are being met.
»  The group includes a person committed to making connections to the local community.
»  Multiple team members assume responsibility for specific tasks.

Additional resources: www.pacer.org/tatra/resources/personal.asp

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 3 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW
Letter  of Intent
A letter of intent (LOI) is an optional, written document that families create to provide details about a person’s life: past, present and future. It is not  a legal document, but  provides invaluable written guidance to those  who will most likely  provide care, support, and/or oversight for the person in the future.
A letter of intent and/or a person-centered plan are your  family’s personal plan for your  loved one with intellectual/developmental disabilities. The PCP and LOI help those  who  support the person to be on the same page  when  planning and coordinating the person’s supports.

Development of the LOI should  include the person as much  as possible, and reflect that person’s unique preferences and needs in every  aspect  of life. It should  include:

Summary and Vision:
A brief  summary of the person’s life to date and general thoughts, hopes, and dreams.

Family History:
Provide information on birthdays, locations, and other important history for family members. Include favorite stories, memories, and feelings about the person.

Daily Routines:
Include typical daily  routines, favorite foods, music, activities, and events  or tasks. Share details about abilities to assist with tasks such as doing the dishes, making the bed, grocery shopping, etc. It is equally important to include strong dislikes  or other “non-negotiables.”

Medical/Health Care:
Share a medical history/health care plan, current/preferred doctors, therapists, hospitals, and frequency and purpose of medical and therapy appointments. List current medications, including how  and why  they  are taken. Describe all medications that have not  worked or have caused  adverse reactions.

Benefits, Financial & Legal:
Include benefits the person receives or is wait-listed for, including Medicaid, Medicare, SSI/SSDI, Supplemental Nutrition Assistance Program (food stamps), housing assistance,  and banking or special  needs trusts. Include contact information, identification numbers, renewal processes, and dates.

Employment:
Describe types of work and environments the person may enjoy,  such as supported employment, volunteer opportunities, or a day program. List any companies that may be of specific interest to the person.

Residential  Environment:
Describe the person’s living arrangements now  and what might be the best future alternative. Consider level of supervision, location, male/female housemates or roommates, etc.

Social Environment:
Describe social activities the person enjoys, such as sports,  dances, movies,  friendships, relationships, community experiences, vacations, and modes  of transportation. Indicate spending money and any limitations or support that is needed.

Spirituality/Religious Environment:
Specify the person’s beliefs,  customs, and place  of worship. Identify religious leaders  who  may be familiar with the person,  and indicate whether religious participation is of interest and important to the person.

Behavior Management:
Describe current behavior management: what works and what doesn’t.

Final Arrangements:
Share any planned services  such as a funeral,  cremation or burial,  or customs.

There are numerous sample LOI formats available. Here are two examples:
»  http://theemarc.org/footprints-for-the-future-184.html
»  http://midmoelderlaw.com/forms/LetterofIntent.pdf

Remember, this is the beginning of a process  that continues throughout a lifetime.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW
Transition Timeline

14	16	17	19	21

•  Become acquainted with the various
aspects of Transition services.
•  Request a pre-IEP Transition Planning meeting and develop an IEP
Transition Planning form.
•  Hold IEP meeting to develop goals and objectives derived from the student needs, interests and desired outcomes for adult life.
•   Research agencies who can provide planned services.

•  Update and strengthen  DESE
Transition Planning form. Revise and update IEP Goals and Objectives.
•  Invite agencies or individuals providing  services for your child to the IEP.
•  Consider work-based learning both inside and out of the classroom.

•  If not started, families and students
should begin the application process for DDS Adult Eligibility.
•  Ensure that school has made a Chapter 688 Referral if the student plans to seek adult services upon graduation at age 22.
•  Prepare information for Social Security Income (SSI) and MassHealth.

•  Refine and strengthen vision
statement. Update and strengthen the IEP Transition Planning form by reviewing data from previous year.
•  Revise and update IEP Goals and Objectives to build on previous year’s successes and change what is ineffective. Make sure they are measurable.

•  Refine and strengthen Vision Statement.
•  Invite Transition Coordinator to ITP if DDS Transition Plan is not done.
•   Receive DDS generated and approved ITP. Revisions can be made if necessary.
•  Work with the Transition Coordinator to become acquainted with service options at age 22. View potential vocational and/or day habilitation programs.
•   Receive Prioritization letters from DDS Area Director identifying the student’s priority of need and subsequent DDS commitment to provide adult services during your 21st year.
•  Select service options (vocational, etc.) with
DDS Area Office/Service Coordinator.

•  Refine and strengthen Vision Statement. Update and strengthen the DESE Transition Planning form by reviewing data from previous year. Revise and update IEP Goals and Objectives to build on previous year’s successes and change what was ineffective.
15

•  Explore “Age of Majority” (age 18) issues. Review and consult with Children’s Coordinator for direction.
•  Prepare to apply for SSI and
MassHealth.
•  Ensure that the DDS Eligibility Application is sent to the DDS Eligibility Team.
•  School district generates the 688
Referral to DDS or other adult human service agency.
17

•  DDS Adult Eligibility process should be completed and eligibility determined.
•  SSI Application should be submitted and determination complete.
•  Transfer of parental  rights occur, unless
a formal Guardianship process has been complete.
•  Pending adult eligibility,  students and parents will be contacted by their assigned DDS Transition  Service Coordinator.
•  Review MCAS, MassCap prioritization materials sent by DDS.
•   Discuss with DDS Transition Service
Coordinator if you have any questions.
•  Apply for Section 8 Housing.
18

•  Refine and strengthen Vision Statement. Update and strengthen the IEP Transition Planning form by reviewing data from the previous year.
•  Invite the DDS Transition Coordinator to the IEP this year. Work with the Transition Coordinator to learn about DDS service option at age 22.
20

•  Eligibility for adult services begins.
•  Meet Adult  Service Coordinator and anticipate setting up an Individual Service Plan (ISP),
if applicable. The ISP usually occurs after a 60-day period of the individual being in a new program.
•  The Transition Coordinator assures that programming has begun and gives family and individual the name and contact of Adult  Service Coordinator.
22

Transition Information Fact Sheet No. 4 • April 2015

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Student’s Role in Transition

In Massachusetts, transition begins  at age 14. This is a natural time  in the life of a student when  the focus is on planning for the future.
For all students, but  especially for those  with more  significant disabilities, support often comes  from the family, advocates, and school personnel. This fact sheet addresses the student’s role, but  is intended to acknowledge the additional support provided by other individuals to assist in the transition process.
The suggestions below fall into  three  different environments: education, home,  and community. There is some overlapping, as many  skills can be taught in multiple settings and by multiple individuals.

Education

»  Learn your  personal learning style  (how you learn best and what accommodations you will need).
»  Become aware  of options for further education through your  guidance counselor/special ed teacher (or workplace coordinator).
»  Identify course  requirements for middle school, high  school,  and post-high-school programs.
»  Complete interest and career  inventories/
assessments.
»  Begin  career  exploration, including visiting employment sites.
»  Understand the purpose of your  Individualized Education Program (IEP) and Transition Planning Form  (TPF), and assist in the development of both.
»  Take part  in informational interviews or job shadowing.
»  Learn to use public transportation.
»  Join a club  or organization in your  school or community.
»  Be able to explain your  abilities and disabilities and any accommodations you might need.
»  Learn and practice how  to make informed decisions.
»  Participate in self-advocacy training.
»  Find out  about your  educational rights.
»  Start  financial planning, budgets, money management.
»  Learn about acceptable intimate/sexual behavior.
Talk with people you trust.
»  Explore technology to enhance  learning.

Home

»  Learn to act and dress for a variety of social situations.
»  Start  financial planning, budgets, money management.
»  Learn to order and dine in restaurants.
»  Learn how  to plan recreation and leisure activities, where,  when, cost of transportation.
»  Learn to schedule medical and dental appointments.
»  Learn the names and purposes of the medications you take.
»  Learn to recognize an emergency and how  to use 911 for assistance.
»  Begin  learning skills you’ll need for independent living.
»  Learn to use public transportation.
»  Explore technology to enhance  learning.
»  Get an ID card  and learn when  and how  to give out  personal information.
»  Establish exercise routines.
»  Develop personal care skills, including hygiene, knowledge of health  needs, private and public behavior.
»  Learn about acceptable intimate/sexual behavior. Talk with people you trust.
»  Develop housekeeping and cooking skills by participating in chores  at home.
»  Learn responsible use of social media.
»  Familiarize yourself with the local bank and learn to perform banking operations.

Transition Information Fact Sheet No. 5 • April 2015

Community

»  Get a Social Security card.
»  Make friends and establish relationships.
»  Learn public transportation and alternatives such as reduced rates.
»  Learn to make clear to others your  interests, wishes, and needs.
»  Volunteer in community.
»  For males, register for selective service  at age 18.
»  Register to vote  at age 18.
»  Visit  work sites to learn about jobs.
»  Participate in community activities.
»  Join community offerings like a church, club, coffee house, etc.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 6 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Family’s Role in Transition

In Massachusetts, transition begins  at age 14 and continues until  a student leaves the school system for the adult world. It is an ongoing process.
The role of the family in the transition process is essential.  Parents  and guardians are the providers of information to schools and agencies; they  know their  children better than anyone else. Parents  play a major role on the Individualized Education Program (IEP) team in helping to develop a vision  for their  child’s future. They help to develop post-secondary goals and objectives that will enable  their  children to become as independent as possible before leaving school.  They teach, model and guide their  children to adulthood, and assist them  in becoming part  of their  communities.
The suggestions below fall into  three  different environments: educational, home,  and community. The purpose is to enable  families to understand the scope  of transition.

Educational

»  Transition begins  at age 14. Participate in creating the Transition Planning Form  with the school.
»  Develop a partnership with the school system, and actively participate on the IEP team.
»  Help your  child  develop advocacy skills to participate in his/her IEP.
»  Become familiar with federal and state laws about transition.
»  Schedule interest inventories and vocational assessments.
»  Identify IEP goals that will capture interests, vocational opportunities, post-secondary education, and independent living skills across settings.
»  Understand the Chapter 688 process and eligibility for adult service  agencies.
»  Make sure your  child  has volunteer experience, internships, and real work experience.
»  Maximize independence by fading supports.

Home

»  Learn about person-centered planning.
»  Focus on self-determination skills: choice making, decision making, problem solving, goal setting, self- management.
»  Encourage independence in all areas of life, including self-care activities, money management, and travel in the community.
»  Talk about the value of work,  and teach behaviors that develop employment potential.
»  Assist in good grooming skills, and emphasize the importance of physical activity.
»  Help children think about and envision their  future.
»  Assist your  child  in understanding his/her disability and medical needs.
»  Investigate requirements for SSI, MassHealth,  and other government benefits.
»  Plan for future needs and assets, including personal finances,  wills, and trusts.

Community

»  Share your  vision  for your  child’s future.
»  Network with other families, community groups, and advocacy groups.
»  Attend transition-related workshops, fairs, and conferences.
»  Provide opportunities for your  children to see people at work in different settings.
»  Identify the human  service  and provider agencies and understand the work that they  do.
»  Encourage relationships and nurture friendships.
»  Use Family Support Centers  and understand the work that they  do.
»  Explore volunteering and connections to community activities.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 7 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Tips for Maximizing  the
Educational  Process

Transition Process

»  Special  education is an entitlement until  age 22.
»  Transition begins  at age 14 in Massachusetts, or earlier  if determined by the Individualized Education
Program (IEP) team.
»  It’s important to learn the young person’s rights and responsibilities from federal and state laws around transition.
»  The years between 18 and 22 should focus on a broad range  of functional life skills across all settings, such as work,  social, community safety,  and travel training.
»  The age of majority in Massachusetts is 18.
»  Be sure your  child’s school submits a 688 referral at least two years before he or she leaves school.

Family Role

»  Parents  and guardians are essential and active members of the IEP planning team.
»  Share as much  information as possible about your  child  with the IEP team.
»  Build  a positive relationship with your  child’s teacher and IEP team.
»  Think  about ways your  child  can participate in the development of his/her IEP in a meaningful way.
»  Request that written assessments and evaluations be provided at least two days prior to the IEP
meeting in order to prepare.
»  Get to know your  child’s Department of Developmental Services  (DDS)  coordinator, and communicate about individual and educational changes and developments.
»  Learn about and access the range  of programs, services,  supports, and accommodations available for young people with disabilities.
»  Attend parent workshops on transition.
»  Apply for SSI/MassHealth when  your  child  is 18 years old.
»  Consider assisting your  child  to apply for Section 8 and other subsidized housing programs.

School Role

»  The Transition Planning Form  (TPF)  is not  a legal document and is separate from the IEP.
»  The Vision,  Goals, and Objectives should reflect your  child’s life at age 22 or when  he or she leaves school.  They should cover educational, vocational, and community experiences, independent living skills, and social skills.
»  The Post-Secondary Vision,  Goals, and Objectives must be transferred from the TPF to the IEP for implementation.
»  Make sure the emphasis on the IEP is on post-school goals that will make the biggest difference in the child’s life.
»  Interest surveys  and vocational assessments should be done  regularly by school personnel starting from age 14 to determine strengths, interests, and preferences.
»  Parents/guardians may request that evaluations and assessments be done  by an independent evaluator.
»  No later than 30 days after receipt of an IEP, a parent can reject part  of or the entire IEP.
»  Make sure travel training is addressed while  the child  in still in school.
»  Discuss shared  and delegated decision-making authority with the child,  and document this in the IEP.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 8 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Federal  and Massachusetts Laws on Transition

Federal  Law: Individuals  with Disabilities  Education  Act (IDEA) – 2004
The purpose of IDEA is to ensure  that all children with disabilities have available to them  a free appropriate public education (FAPE).  FAPE emphasizes special  education and related services  designed to meet  children’s unique needs and prepare them  for further education, employment, and independent living.
One specific component of IDEA is related to “Transition Services.” This means a coordinated set of activities for a child  with a disability that:
1.  Are designed to be within a results-oriented process,  that is focused on improving the academic and functional achievement of the child  with a disability to facilitate the child’s  movement from school  to post-school activities, including postsecondary education; vocational education; integrated employment
(including supported employment); continuing and adult  education; adult  services;  independent living or community participation;
2. Are based on the individual child’s  needs, taking into  account the child’s  strengths, preferences, and interests; and
3. Include instruction, related services,  community experiences, the development of employment and other post-school adult  living objectives and, when  appropriate, acquisition of daily  living skills and functional vocational evaluation.

WHAT  THIS LAW MEANS TO YOU
Each Individualized Education Program (IEP) starting at age 16 must include:

1.     At least one appropriate, measurable postsecondary goal based  upon  age-appropriate transition assessments in each of the following areas: training, education, employment, and, where appropriate, independent living skills; and
2.  The transition services  and school work needed to assist the child  in reaching those  goals.

Massachusetts Law Chapter  285 of the Acts of 2008 (section 2 of c.71B)
Beginning at age 14 or sooner  if determined appropriate by an individualized education program team, school-age children with disabilities shall be entitled to transition services  and measurable postsecondary goals, as provided under  the federal Individual with Disabilities Education Act. 20 USC sec. 1400.

WHAT  THIS LAW MEANS TO YOU
Although the federal law states that transition activities start at age 16, Massachusetts starts  transition services  at age 14.

Massachusetts Law Chapter  688, “Turning 22” Law (Chapter 71b, Section 12c)
A disabled person who  has been receiving special  education shall be eligible, subject to appropriation, upon  graduation from high school  or upon  attaining the age of twenty-two, whichever occurs  first,  to receive  habilitative services. The education authority which  is responsible for the education of a person with a disability shall, with the consent of such person or his parent or guardian, at least two  years
before such person attains the age of twenty-two or at least two  years before such person’s graduation, whichever first occurs,  determine whether such person may need continuing habilitative services  and
notify the bureaus  of transitional planning of the name an address  of such person,  the record of the special education services  being  provided to such person,  and the expected ate of termination of such services.

WHAT  THIS LAW MEANS TO YOU
It is the responsibility of the local school system to make a Chapter 688 referral for adult services  for each student needing continued services  upon  leaving special  education. The referral must be made  while  the student is still in school and should be made  at least two years in advance of graduation or turning 22.
A 688 referral is needed even if a student is already known to the Department of Developmental Services  (DDS) and eligible for adult services.  The school system can send the 688 referral directly to the adult service  agency best suited to serve the individual as an adult.
If DDS is the designated agency,  the referral can be sent directly to the Area Office that covers the referring school system. If the school system is unsure  which agency would best serve the individual, the referral can be sent to the Bureau  of Transitional Planning at the Executive Office of Health  and Human  Services  for assistance.
Eligibility for Chapter 688 is broad and does not  guarantee eligibility for DDS or any other specific adult human service  agency.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 9 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Chapter  688 / Turning 22

WHAT  is Chapter  688?

Chapter 688 is a law enacted in 1983 to provide a two-year planning process for young adults with severe disabilities who  will  lose their  entitlement to special  education at the age of 22, or at the time  of graduation from high  school,  whichever comes  first.  The law creates a single  point of entry into  the adult human  service  system.

WHO  is eligible  for Chapter  688?
To be eligible for Chapter 688 services,  a person must:

»  Be receiving special  education paid  for by the Commonwealth of Massachusetts
»  Need  continuing habilitative services  at the time  of turning 22 or graduating from special  education,
and
»  Be unable  to work competitively (without specialized supports) for more  than 20 hours  per week  at the time  of leaving school.

An individual  is automatically eligible  for Chapter  688 if receiving  SSI, receiving  SSDI, or registered with the Massachusetts Commission for the Blind.

HOW  is a 688 referral  made?

»  Only  the local  school system, also known as the Local  Education Authority or LEA, can make  a
688 referral. The referral must be made  while  the student is still in school.  The local  school system typically decides which adult human  service  agency,  referred to as the Transitional Agency, might best meet  the student’s needs as an adult,  and sends the referral directly to that agency.  If an individual is being referred to the Department of Developmental Services  (DDS),  the referral typically is sent directly to one of the DDS area offices.
»  If a student or parent believes that a 688 referral has not  been made,  they  should contact the special education department at the school,  or the director of special  education services  for the school system. Although there  is only  one Transitional Agency for each student, multiple adult agencies can plan and provide services.

WHEN  should a 688 referral  be made?

»  Chapter 688 requires the school system to make  the 688 referral two years before a student graduates or turns  22, whichever is earlier.  In order to facilitate the planning process,  DDS prefers to have the 688 referral earlier  than  required by Chapter 688. DDS suggests that referrals be made at age 18 to coincide with DDS adult eligibility age requirements. Referrals that are made  less than two years before graduation do not  afford adequate planning time  to assist a student in the most meaningful way  possible.
»  Students or families who  are concerned about the timing of a 688 referral should contact both the school system and the local  DDS area office, if they  feel DDS would likely  become the Transitional Agency.

IF a student is already  known to DDS, is a 688 referral  still necessary?

»  Yes. Even though some individuals with an intellectual disability receive DDS services  as children, a
688 referral still should be made.  The 688 referral starts  the formal DDS transition planning process for the individual student.

WHAT  is the “SPED DATE” and why is it important?
The special  education date (“sped date”) is the date on which a student is planning to leave special education and school.  Typically, the sped date is either the student’s expected date of graduation or 22nd birthday. The sped date is used in the 688 referral process as the reference date for planning. Students

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 9 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

leaving on short  notice in advance of the sped date specified on the 688 referral may not  have the benefit of adequate planning time  to assist with a smooth, well-planned transition.

WHAT  happens if a student leaves school without  a 688 referral?

If a student leaves school without a 688 referral being made, he or she is not  eligible for specialized planning through 688. The student can still apply to DDS or other state agencies serving adults at any time,  as any citizen could.

WHAT  if a 688 referral  is made to DDS and the person is found ineligible for DDS?

When  a 688 referral is made  to DDS, DDS determines if the student is eligible for adult supports through the agency.  If the person is eligible for 688 services  but  is not  eligible for DDS services,  DDS transfers the case to the appropriate state agency for 688 planning assistance.
The transition coordinator in the local DDS Area Office must send a complete package of material for the ineligible person to the DDS Central Office in order to complete the transfer. In addition to supporting material, a copy of the 688 referral and the DDS ineligibility letter are included in the transfer packet. The transfer will be completed by the Central Office and sent to the appropriate agency.
In order for a 688 referral to be transferred to another agency,  there  must be at least six months lead- time  before the student leaves school.

WHAT  are the benefits  of the 688 process for individuals  eligible  for DDS adult services?
»  The 688 process ensures  that the student is working with DDS before exiting school.
»  The 688 process specifies a referral timeline that allows  for sufficient planning to support a smooth transition to adult supports.
»  The Individual Transition Plan (ITP) enables  DDS to understand the student’s needs and to begin programmatic and fiscal planning.
»  By specifying an individual’s needs before exiting special  education, the individual, family, and
DDS can plan together.

WHAT  is the role of the DDS 688 transition  coordinator?

The 688 transition coordinator is a case manager who  works at the local DDS Area Office. Once a student is determined DDS adult eligible, a transition service  coordinator will be assigned.
The coordinator is the student and family’s primary link to assistance from DDS during the transition process from special  education to adult life. He or she visits  the student’s program and assists in identifying future community supports that are consistent with the individual’s vision  and ITP.
The 688 transition coordinator also chairs the ITP meeting and develops the written ITP which identifies future adult community support service  needs for the student.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 10 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

DDS Adult Eligibility

Individuals can be determined eligible for adult services  through the Department of Developmental Services
(DDS)  if they  have significant limitations in adaptive functioning and one or more  of the following diagnoses:

»  Intellectual Disability
»  Autism Spectrum Disorder
»  Prader-Willi Syndrome
»  Smith-Magenis

In order to receive services  at age 22 or later, adult eligibility must be completed, even if the individual has been determined eligible for children’s services.  It is best to begin the adult eligibility process around age 18 in order to provide maximum planning time  for adult services.  Adult services  do not  begin prior to age 22.

When to Apply:
Around age 18.

Where  to Get an Application:

ONLINE
Go to www.mass.gov/dds. Under “Related Links,” click  on:
1.     Application for Eligibility
2.  Application for Eligibility Forms
3.  Application Form  for Adult Eligibility

Download the form, complete it, and mail it to your  regional office. Cities and town pages  are included with the application to help you identify your  regional office.

BY PHONE
»  Call your  DDS regional office:
»  Central West Region:  413-284-5045
»  Metro Region:  781-314-7513
»  Northeast Region:  978-774-5000, ext. 850
»  Southeast Region:  508-866-5000

IN PERSON
»  Visit  any area office, family support center, or autism support center for assistance.

Criteria  for DDS Eligibility Based on Intellectual Disability

»  Must live in Massachusetts
»  Must have a diagnosis of an intellectual disability (originates before 18)
»  Must have significant limitations in adaptive functioning

What  to submit for an application based on intellectual disability:

1.     All available intelligence/cognitive/psychological testing reports
2.  Early Intervention  Plans
3.  IEP and related assessments
4.  Adaptive Behavior Assessment System (ABAS) or Vineland II
5.  Individual Family Support Plan
6.  504  Accommodation  Plan
7.   Medical,  developmental, and specialty assessments
8.  Hospital reports (if applicable)

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 10 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Criteria  for DDS Eligibility Based on Autism Spectrum  Disorder

»  Must live in Massachusetts
»  Must have a primary diagnosis of Autism Spectrum Disorder determined by a qualified professional (manifests before 22)
»  Must have significant limitations in adaptive functioning

WHAT  TO SUBMIT FOR AN APPLICATION BASED ON AUTISM SPECTRUM DISORDER:

1.     Autism Diagnostic Testing results:
»  Gilliam  Autism Rating Scale (GARS)
»  Gilliam  Asperger’s Disorder Scale (GADS)
»  Childhood Autism Rating Scale (CARS)
»  Autism Diagnostic Observation Schedule (ADOS)

2.  All available intelligence/cognitive/psychological testing reports
3.  Diagnostic reports of diagnosed developmental condition
4.  Most recent IEP and related assessments

For All Applications, Submit:
Please submit copies  only, do not submit original documents.

»  Birth certificate
»  Social Security card
»  Health  insurance card
»  Guardianship decree (if applicable)
»  Proof of domicile as necessary

All requested documentation may not apply to each individual.

Eligibility Determination

Once  all the paperwork has been submitted, you  will  be contacted by an eligibility specialist to set up an intake interview. This is a face-to-face interview. The location will  be determined by the eligibility specialist and the individual and family.
All the materials and information will  be reviewed by the regional eligibility psychologist. The applicant or guardian will  be notified in writing of the eligibility determination. There is an appeal process if the applicant is found to be ineligible.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

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Supports for Adults with
Autism Spectrum  Disorder

Background

The Department of Developmental Services  (DDS)  has provided supports to children with autism and adults with autism who  met  the department’s eligibility criteria for intellectual disability. In 2010, the legislature established an Autism Commission to investigate the needs of individuals with autism spectrum disorders (ASD),  including those  who  did not  meet  the criteria for DDS as related to intellectual disability. After extensive study, the Autism Commission developed a comprehensive report that identified a number of priorities, findings and recommendations.
The Massachusetts Autism Commission Report, issued in March 2013, identified a number of priorities, including:
»  Expand the eligibility for DDS so that individuals with autism who  have higher IQ scores and substantial functional limitations have access to services.
»  Ensure that individuals with autism with co-occurring mental health  conditions have access to services  from the Department of Mental  Health.
»  Expand insurance coverage for treatment for individuals with autism.
»  Increase  employment, housing, educational, and health  care options for individuals with autism.
»  Determine the number of people with autism in Massachusetts and their  needs by consistent data collection.

Autism Omnibus Act

In 2014, the governor signed  the Autism Omnibus Act  into  law in order to expand supports and services  to individuals with autism living in Massachusetts. This legislation establishes a permanent Autism Commission to oversee the implementation of autism services.  It also creates the opportunity for families to establish tax-advantaged accounts to use for their  family member with a disability. It requires the Board of Elementary and Secondary Education to revise  educator licensure to provide a mechanism for special education teachers to achieve  Autism Endorsement through mastery of specialty training and skills. Insurance coverage to cover services  for individuals with autism is expanded as a result  of this legislation.

What  does this mean for DDS?

Eligibility for supports through DDS has expanded. The criteria for children and for adults with intellectual disability have not  changed. Eligibility for adults with ASD, Prader-Willi Syndrome, and Smith–Magenis Syndrome has been added. Provision of adult services  begins  at age 22.
IQ (Intelligent Quotient) is not  a criteria for individuals with ASD and Prader-Willi Syndrome. Individuals with these diagnoses can be eligible without having an intellectual disability. In order to be determined eligible for ASD services,  an individual will need a verified diagnosis by a qualified professional, and
for Prader-Willi a genetic testing result.  The qualifying disability must manifest prior to age 22 and be determined to continue indefinitely.
In addition to the diagnosis, the individual must have substantial functional impairments in three  or more areas of seven major  life areas. The major  life areas are self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living,  and economic self-sufficiency.

What  will happen after eligibility?
After an individual has been determined eligible, he or she will be contacted by a DDS assessor who specializes in conducting the Supports Intensity Scale® (SIS). The SIS is a standardized assessment tool that will help in service  planning. The individual will also be referred to the DDS Area Office closest to that person’s home  for assistance with planning and services.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

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TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

In the event  that the individual has a 688 referral and is under  22, the planning requirements of Chapter 688 will be met. Using a person-centered planning process,  the individual will receive assistance from a DDS Service  Coordinator to determine service  needs, preferences and options. The Service  Coordinator will help the individual locate and arrange supports.
Services  provided by DDS are dependent on availability and funding. It is anticipated that some individuals can be supported on existing service  models, while  other individuals will need and benefit from new services  and or/individualized options. The Autism and Family Support Centers  funded by DDS are also available to provide information, support, and resources to individuals and families.

What  services will be available?

Community Developmental Disability Services  will be made  available and include the following types of services:  employment/day services;  individual supports to assist individuals who  may be living more independently; support services  for assistance both in-home and in the community, such as adult companion, individualized home  supports, behavioral supports and consultation, and peer support; and family support services  for individuals living with their  families, including respite, family
training, and flexible funding. Individuals have the option to receive services  from traditional providers or can choose  one of the self-directed service  options, the Participant-Directed Program or Agency With Choice  Program.

Ongoing  Development
With experience it is expected that our understanding of the support needs of this new, diverse population of adults with ASD will continue to evolve. DDS is committed to the ongoing development of services  to be able to provide quality supports and assistance relevant and responsive to the needs of this group of individuals. This will involve additional education and training and strong partnerships with providers, individuals and families, and other stakeholders.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

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TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

MASSCAP and Prioritization

What  is MASSCAP?

MASSCAP is the Massachusetts Comprehensive Assessment Process. It consists of two components: the
Inventory of Client  and Assessment Planning (ICAP),  and the Client  and Caregiver Assessment (CCA).

MASSCAP provides a consistent and fair process across the state. Combined with professional judgment, it helps determine an individual’s needs for services  and the priority for services  with consideration of health and safety factors. Both  the ICAP and CCA are conducted through interviews without the individual present.

Inventory of Client and Assessment Planning (ICAP)

The ICAP is a standardized, proprietary instrument that assesses the functional skills and behavioral limitations of an individual. It is conducted through an interview process with an informant who  has current knowledge of the individual’s everyday functioning. Often, the informant is a family member. In some cases where the individual is placed out  of the home,  the informant is a current caregiver.
The ICAP assessment is usually  completed during the intake and eligibility process by the Department of Developmental Services  (DDS)  eligibility specialist. The ICAP process results  in a score from zero to 100, with lower scores typically suggesting greater needs for supervision and support. The ICAP can be reviewed or redone in the event  of significant changes in the individual’s needs or functioning.

Client and Caregiver  Assessment (CCA)

The CCA is a tool developed by DDS to understand the resources available to the individual, including the family caregiver’s capacity to provide care in the home.  This capacity may be impacted by factors such
as age, physical and mental health,  the number of caregivers in the home,  the number of dependents the caregiver is responsible for, and the capacity of the caregiver to provide a safe, supervised environment.
The CCA assessment does not  result  in a numeric score, but  does provide a valuable summary of the caregiver’s capacity to provide ongoing supervision. Typically, the CCA is conducted by a member of the area office MASSCAP team. It takes place  in the home  of the caregiver prior to planning for services  for the individual.

Changing Needs

The ICAP, CCA, or both can be re-administered any time  that DDS area office staff  recognize that the individual or caregiver has experienced significant changing needs.

Prioritization

An individual is prioritized only  for services  that have been requested. Services  can be requested during the eligibility process for adult services,  or later as the individual and family work with the 688 transition coordinator.
Prioritization for comprehensive 24/7 residential supports requires a thorough review of health  and safety factors during the MASSCAP process.  An individual’s priority status  can be appealed, but  the MASSCAP and its components are not  subject to appeal.

Prioritized services  do not begin  until  a student turns  22 or special  education entitlements have ended. Family  support services  may be available while  a student is still in school.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

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TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Supports Intensity  Scale (SIS)

What  is the Supports Intensity  Scale?

The Supports Intensity Scale® (SIS) is a person-centered assessment for adults with intellectual and developmental disabilities. It is an individualized assessment, using  a positive, strength-based approach, which provides a way to measure  the types of supports individuals will need in their  daily  life.
The SIS is used across the country and around the world, and the Department of Developmental Services  (DDS) is beginning to implement it here in Massachusetts. The assessment is administered by certified assessors, and is statistically established, reliable, valid, and fair.

Who receives a SIS assessment?

At this time,  individuals found newly eligible for DDS with Autism Spectrum Disorder, Prader-Willi, or Smith- Magenis  will be contacted in order to participate in a SIS assessment. In addition, individuals with intellectual disability who  will be transitioning from special  education to adult services  may also be contacted to participate in a SIS assessment.

How is the SIS assessment administered?

A SIS assessment is conducted by a specially trained DDS SIS assessor, and should include least two people (respondents) who  know a great deal about the individual’s daily  support needs. The individual being assessed is encouraged to attend, and may serve as a respondent if he or she is able. It is best if respondents are from diverse areas of the individual’s life, such as one family member and one professional.
The SIS assessment takes place  at a location that provides privacy and is mutually agreed upon  by those  involved. The assessment can take up to three  hours  to complete.

What  kinds of questions will be asked?

Topics relate to quality of life, and include medical and behavioral supports, home  and community living,  social activities, lifelong learning, employment, health,  safety,  and protection and advocacy.
The focus of the assessment is to identify what supports the individual would need to successfully take part  in all activities, as compared to a typical person of the same age in his or her community.

The SIS assessor will identify answers to these questions:

»  What types of support would be needed for the individual to be successful?
»  How  frequently would the support be needed?
»  How  much  support time  would be needed cumulatively over  a twenty-four hour  period?

How will the SIS be used?

The results  of the SIS can be used to design  a person-centered plan that aims to meet  the individual’s unique needs.
Results will be processed electronically. The individual/family/guardian and DDS service  coordinator will receive hard copies  of the report for individualized service  planning.
The SIS report can be shared  with providers as part  of the Individual Support Plan (ISP) process.  It can help the team to plan what supports would be needed for an individual’s success.

For additional information:

»  http://tinyurl.com/ma-dds-sis
»  http://aaidd.org/sis

The Supports Intensity Scale (SIS) is a registered trademark of the American Association of Intellectual and Developmental Disabilities (AAIDD).

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ADULT SERVICES

The Department of Developmental Services  (DDS)  provides an array  of service  options for adults.  Each DDS area office contracts with a variety of qualified adult provider agencies to provide these services  and not  all area offices contract with the same agencies.

Referral Process

When  an individual has been prioritized for DDS-funded day and/or residential services,  and a particular
option is identified in consultation with the person’s family/guardian, a referral is made  by DDS to that provider agency.  The referral is sent to the agency that provides the service  that can meet  the individual’s needs. The agency that receives the referral will then  complete an intake to determine whether or not  they  can safely  and effectively serve the individual. Agencies must have the capacity to serve a person.  Once a person has been accepted by an adult provider agency,  a team meeting is held with the family, school,  etc. and the transition planning process is identified. The time  frame varies, by area office, provider agency,  and availability.

DDS-Funded Models of Employment/Day Services

DDS is committed to promoting and assisting individuals who  are motivated to work to become employed in integrated jobs in the community. This is consistent with DDS’s Employment First policy and mission to support individuals to “fully and meaningfully participate in their  communities as valued  members.” DDS has a network of providers that offer an array  of employment-related supports to individuals. Providers are
encouraged to individualize supports and create maximum flexibility to assist each person to achieve  his or her employment goals. Some individuals may choose  to participate in a combination of models of day services. Below is a summary of day service  options:

INDIVIDUAL SUPPORTED EMPLOYMENT
Individual Supported Employment includes an array  of services  designed to assist individuals to obtain and maintain a job. The plan is for an individual to have a job, based  on identified needs and interests, located in a community business; or to be self-employed and own  his or her own  business.
Supported Employment services  may include assessment, career  planning, skills training, job development and placement, job coaching at the job site, and ongoing supportive services  to assist the person to successfully maintain employment. Regular  or periodic assistance,  training, and support are provided for the purpose of developing, maintaining, and/or improving job skills, fostering career  advancement opportunities, and helping to ensure  job retention.
Natural supports are developed by the provider to help increase  inclusion and independence of the person within the community setting. When  hired  at a job, individuals are expected to have regular contact with co- workers, customers, supervisors, and people without disabilities, and to have the same opportunities as their co-workers without disabilities.

GROUP SUPPORTED EMPLOYMENT
Group  Supported Employment is the provision of skills training, job coaching, and supervision to a small group of people (on average 4 to 6), working in the community under  the supervision of a provider agency.  Group Supported Employment may include small groups in industry (enclave); provider businesses/small business model; and mobile work crews  which allow  for integration, such as a cleaning or landscaping crew.  This service can provide individuals the chance  to explore career  interests and different types of work and work settings, and assist in the development of work skills, work habits,  endurance, and/or independence.
While  the goal is to help people move  into  individual, integrated jobs at businesses  through Individual Supported Employment, it is recognized that this employment model may be an appropriate alternative for some people on a long-term basis, based  on their  high  level of need for consistent support, structure, and supervision in order to be successful on a job.

COMMUNITY-BASED DAY SUPPORTS (CBDS)
This array  of supports is designed to enable  a person to enrich  his or her life and enjoy  a full range  of

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

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TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

community activities by providing opportunities for developing, enhancing, and maintaining competency in personal, social, and community activities.
Services  include, but  are not  limited to, the following options:

»  Career exploration, including assessing of interests through volunteer experiences or situational assessments.
»  Community integration experiences to support fuller  participation in community life.
»  Skill development and training.
»  Development of activities of daily  living and independent living skills.
»  Socialization experiences and support to enhance  interpersonal skills.
»  Pursuit of personal interests and hobbies.

This service  is intended for:

»  Individuals of working age who  may be on a pathway to employment.
»  A supplemental service  for individuals who  are employed part-time and need a structured and supervised program of services  during the day when  they  are not  working, which may include opportunities for socialization and peer support.
»  Individuals who  are of retirement age, who  need and want to participate in a structured and supervised program of services  in a group setting.

DDS-Funded Models of Residential  Services

The goal of all residential support services  is to ensure  the health  and safety of each person and provide all supports needed,  while  at the same time  working to foster personal growth and maximum independence.

RESIDENTIAL
These homes  offer 24-hour residential supports in a group setting. Oversight, training, and supervision are provided by staff  employed by a provider agency.  This model of DDS-funded residential services  is provided to those  who  have significant health  and/or safety needs and require the most intensive level of support.

SHARED LIVING
Shared  living is a residential support in which a person resides  with a non-family member (host family) in their  home.  Provider agencies who  offer shared  living services  recruit host families and work to match a person with an optimal living situation that offers an appropriate level of support and supervision. These agencies are responsible for providing oversight, training, and assistance to the host families.

INDIVIDUAL SUPPORTS
Individual Supports are provided outside of the family home,  assisting people to live in and maintain a household. Individuals who  receive these services  do not  require 24-hour residential support, but  typically need intermittent assistance and training in order to maintain their  own  apartment or independent living situation. The number of hours  of support a person receives per week  is based  on the assessed needs and focuses on Independent Living Skills. Services  may include the acquisition, retention, or improvement of skills related to personal finance,  health,  shopping and menu planning, community and personal safety, and use of generic community resources to live in the community.

SELF-DIRECTION
Some people choose  to self-direct their  supports in order to create unique,  flexible options. The individual must be prioritized for supports and assigned an allocation before self-direction planning can begin.  Self- directed services  require the development of a vision,  plan and budget.
There are two models of self-direction that are available: the Participant-Directed Supports Program, and the Agency With Choice  Program. In order to self-direct supports, the person or family/legal representative must be interested to plan for, hire, and supervise staff  with the help of a support broker, or to share responsibilities with an Agency With Choice  provider.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

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TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Masshealth/Medicaid-Funded Supports

DAY HABILITATION PROGRAMS
Day Habilitation Programs (Day  Habs) are funded and licensed by MassHealth and typically serve people who  require more  clinical and therapeutic assistance,  are not  able to work full time,  and who  might desire  a day structured around social, recreational, and therapeutic activities.
»  A day habilitation program provides the following services:
»  Nursing Services  and Health  Care Supervision
»  Developmental Skills Training
»  Therapy Services  (Occupational Therapy, Physical  Therapy, Speech  and Language Therapy, and
Behavior Management)
»  Assistance with Activities of Daily Living
»  Day Habilitation Service  Management

ADULT FAMILY CARE (AFC)
Adult Family Care is a program for people ages 16 and older  with disabilities who  cannot live alone safely. Persons live with trained paid  caregivers who  provide daily  care. Caregivers may be family members (except legally responsible relatives) or non-family members. Individuals must be Medicaid-eligible in order to participate in the AFC program.

PERSONAL CARE ATTENDANT SERVICES (PCA)
A PCA is hired  by a person with a disability to assist with his or her personal care routine. Persons are eligible if they  qualify for Medicaid, have a severe, chronic disability, and require physical assistance in personal care. The number of PCA hours  a person qualifies for is assessed and determined by MassHealth.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

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TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Participant-Directed Supports Program

Some individuals wish to have choice and control over  all aspects of their  service  delivery, including decisions about how  their  Department of Developmental Services  (DDS)  funds  are used to support them.  This
involves finding and hiring support staff,  managing an individual DDS budget, and working with a financial management service  to process invoices and payments.
For these people, participant direction may be an option to consider. Individuals may do this with the help of family, a guardian, friends, and their  DDS service  coordinator/support broker.
This self-directed support model is referred to as the Participant-Directed Program. There are guidelines that must be observed, although great efforts have been made  to preserve the flexibility and creativity that this model affords. The individual determines what supports will be provided based  on specific needs identified
in the Individual Support Plan (ISP).

The participant-directed model offers the following key components:

DDS SUPPORT BROKER

»  Works in full partnership with the individual/guardian to customize a support arrangement that will meet  the individual’s needs, and to develop an individualized budget. This includes assistance with the hiring process: developing job descriptions, creating interview questions, supporting worker recruitment, and negotiating wages.
»  Assists  with the online  registration and credentialing process for new workers.

»  Takes full responsibility for drafting and revising the individual’s budget.

»  Assists  the individual in monitoring the budget/spending so the individual will know if spending of DDS
funds  is as planned. Helps make adjustments to stay within the budget as necessary/directed.

»  Supports the individual with making changes to the budget as often as necessary,  in accordance with changing needs.

FINANCIAL MANAGEMENT SERVICE

DDS contracts with Public  Partnerships (PPL) to provide this service:
»  Responsible for processing completed employee registration, credentialing, and paperwork to help the individual hire support staff.
»  Assists  in the financial management and accountability of the individual’s DDS resource allocation, and assumes employer fiscal responsibility (e.g., payroll, taxes, worker’s compensation).
»  Processes  payroll as well as payment for specialized services  and goods.
»  Provides a monthly financial report, as well as real-time online  access to review the individual’s budget.

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TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Agency With  Choice Program: Co-Directed Supports

Some individuals wish to have shared  responsibility in selecting their  support people and directing the day-to-day activities of their  staff.  For these people, the Agency With Choice  model of support may be an option to consider.
Individuals who  choose  this support model will have an individual budget allocation for the purchase of services  to meet  their  needs. The individual/family/guardian is able to identify the people they  wish to employ with the support of an agency to assist in the hiring process,  payroll management, and other related tasks.
The Agency With Choice  program offers the following:

»  A co-employment model in which the agency serves as the employer, partnering with the individual/family/guardian to help train and manage staff.  This enables  the individual/family/ guardian to serve as the managing employer.
»  The agency agrees  to interview, hire, and negotiate a pay rate for the person or people the individual/family/guardian identifies to provide support, subject to agency personnel policies.
»  The individual/family/guardian has responsibility for daily  supervision of workers, as well as the decision to no longer use a particular worker.
»  If the individual/family/guardian chooses to discharge a particular worker, that person may continue to work for the agency in a different capacity if the agency chooses.
»  The agency assumes responsibility for paying workers identified and hired.  This includes withholding, filing,  and paying federal and state income and employment taxes, as well as providing a worker’s compensation policy.
»  The agency provides the individual with a monthly financial report so the individual is aware  that spending is occurring as planned and can make adjustments if necessary.
»  Service  options within the co-directed Agency With Choice  program model include:

•  Adult Companion Services
•  Individualized Home  Supports
•  Respite
•  Individualized Day Supports
•  Family Training
•  Peer Support
•  Behavioral Support and Consultation
•  Family Service  Navigation
•  Financial Assistance

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Employment First Initiative

Over  the past several  years, the Department of Developmental Services  (DDS)  has been working on an Employment First initiative. This is a plan to expand integrated employment for people with intellectual and developmental disabilities, and to phase out  center-based/sheltered workshop services.
DDS is working with day and employment providers to get  more  full-time and part-time jobs for the people we serve. One primary reason  for this is the expressed preference of many  individuals and their  families for competitive employment opportunities.
As of January 1, 2014, no new referrals can be made  to sheltered workshop programs. DDS’s goal is that the sheltered workshop model will be phased  out  by June 30, 2016. Individuals currently served  in sheltered workshop situations will transition to individual or group supported employment, or to community-based day services.  DDS is committed to supporting individuals during non-work hours  in needed day services  in a manner that maintains stability for families.
The DDS transition coordinator will plan with the individual and family to identify the most appropriate employment and day options available when  the individual graduates. Typically, this requires a team approach, with all team members contributing toward a successful outcome.
Some individuals and families may craft a unique employment option, or may combine several  models to create a meaningful experience. The option at graduation is a first step, and may evolve as the individual has different experiences and continues to develop and grow.

Factors to consider when planning:

»  The student’s employment experiences, skills, and training and supervision needs.
»  The student’s travel and transportation skills and needs.
»  The opportunity to build upon  any current employment skills or jobs.
»  The location of the employment or training situation.
»  Flexibility and creativity in hours, scheduling, and transportation options.

Service Definitions

INDIVIDUAL SUPPORTED EMPLOYMENT
An individual receives assistance from a provider agency to obtain an integrated, paid  job based  on identified needs and interests. A job coach  provides regular or periodic assistance,  training, and support so that the individual can develop, maintain, and/or improve job skills and achieve  successful job retention. Natural supports are developed by the provider to help increase  the individual’s inclusion and independence in the community.

GROUP SUPPORTED EMPLOYMENT
A small group of individuals work at businesses  in the community with the supervision of a provider agency. Individuals have contact with co-workers, customers, supervisors, and other individuals without disabilities. Individuals may work in industry/businesses, mobile work crews,  and temporary services.

COMMUNITY-BASED DAY SERVICES
Individuals are supported to enrich  their  lives through a full range  of community activities while  developing
and enhancing personal and social competency. Services  can include career  exploration, volunteer experiences, community integration activities, skill development, and training in activities of daily  living,  independent living, and social skills. This model may be a pathway toward employment for some individuals.

DAY HABILITATION
Day habilitation services  are funded by MassHealth.  Services  are based  on a service  plan of goals and objectives and a program of integrated activities and therapies to help participants achieve  optimal physical and cognitive capabilities. Employment and related activities are not  included in the day habilitation model of services.

PARTICIPANT-DIRECTED EMPLOYMENT  AND INDIVIDUALIZED DAY SUPPORTS
Supports provided to individuals tailored to their  specific goals and outcomes. Individuals acquire, improve, and/ or retain skills to prepare and support them  for work and/or meaningful community participation. Individuals work closely with DDS staff  on needs assessment, prioritization, planning, and budget development, and have primary responsibility for the hiring of support staff.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 18 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Transportation

Travel  and transportation arrangements are an important aspect of a successful transition to adult life. Individuals leaving school use a variety of transportation options. Many travel independently by public transportation or specialized public transportation (e.g., THE RIDE paratransit service). Others arrange rides with family members, friends, co-workers, volunteers, or provider staff.
The Human  Service  Transportation (HST)  Office, a part  of the Executive Office of Health  and Human  Services, oversees  transportation to day and employment programs, as well  as to day habilitation programs, for individuals served  by the Department of Developmental Services  (DDS).  The HST Office manages  contracts with six Regional Transit Authorities (RTAs).  In turn,  the RTAs subcontract with local  transportation companies that hire and train drivers for vans and sedans maintained by the company. Transportation is provided if there are routes and seats available.

Tips for Arranging  Successful Transportation

»  If feasible, take advantage of travel training activities while  still in school to maximize the rider’s independence.
»  Consider whether public transportation or specialized public transportation is an option.
»  When  considering employment or a day program, consider location. CLOSER IS USUALLY BETTER FOR TRANSPORTATION.
»  If HST Office transportation is beneficial, work with your  688 transition coordinator on a transportation request (TR). The service  coordinator will submit the TR to the HST Office on behalf of the individual.
»  Make sure the DDS 688 transition coordinator is aware  of important physical, medical, or behavioral needs of the individual.
»  Try to be flexible and realistic about the available transportation options.

A Few Points About  HST Services

»  The HST Office provides curb-to-curb service.  The driver can assist an individual in and out  of the vehicle, but  cannot help the individual in or out  of the home.
»  As much  as possible, transportation companies try to assign permanent drivers to each route so that individuals, families, and staff  know each other.
»  Transportation companies are required to conduct a Criminal Offender Record Information (CORI) check on each driver before hire and annually thereafter.
»  Transportation routes have established pick-up and drop-off times  in a particular order.  Drivers are not able to change  these times  unless instructed to do so by the transportation company. There is a 15-minute window before or after the designated pick-up or drop-off time.
»  Routes  are designed so that individuals are not  on the route more  than 90 minutes one way.
»  If the vehicle arrives  at a residence and no one is home  to greet the individual, the driver will work with the transportation company, the RTA, and DDS to resolve the situation. The individual will not  be left unattended unless a “Home Alone” authorization has been completed and is on file at the HST Office.
»  There is a complaint resolution system in place  to resolve situations in which individuals and families feel that transportation standards have not  been met.
»  The HST Office does not  provide transportation to individuals working independently.

Transportation to Locations Other than Day and Employment

»  Some individuals receiving MA health  are eligible to receive individual transportation to appointments and activities approved as medically necessary through PT-1 requests.
»  Although DDS-sponsored transportation options for social and recreational activities are limited, some family support centers and other entities do provide or assist in arranging transportation to some activities and events.
»  The HST Office website (www.mass.gov/hst) provides information about other transportation and travel
resources.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Family Support, Recreation, and Friendships

Family Support  Centers

The Department of Developmental Services  (DDS)  has established and funded Family Support and Autism Support Centers  throughout the state in order to support children and adults living at home  with their  families. In addition, some areas have established Cultural/Linguistic Specific Family Support Centers  in order to best serve families in those  areas. Each center is created to respond to the unique needs of the families they  support.
Family Support Center  staff  work with families to identify assistance or information that will be useful  to them. They work individually, providing support and ensuring follow through.
Centers  are rooted in communities and act as a hub for offering a wide  range  of services  based  upon  need, interest, and available resources, including but  not  limited to:
»  Information and referral
»  Service  navigation
»  Knowledge of generic, state, and federal resources that will support the family
»  Family training
»  Networking opportunities
»  Administration of DDS-approved flexible funds
»  Respite
»  Opportunities for socialization
»  Peer mentoring
»  Recreation opportunities

A statewide listing of the Family Support, Cultural/Linguistic-Specific, and Autism Support Centers  can be found at www.mass.gov/dds.

Social & Recreational Opportunities

Staff  at the Centers  gather information from cities  and towns they  serve as well as other interesting events  and activities throughout the state. With input from families, Family Support Centers  create opportunities for social/ recreational activities by either sponsoring an activity or supporting other agencies in their  efforts.
Collaboration with community groups is important for individuals to become an active part  of their  community and begin to understand what local resources and opportunities exist. This can be done  through calendars, Internet sites, and newsletters. Centers  may also coordinate activities throughout the area so families do not have to travel from their  own  communities to gain access to recreational/ social activities.

Friendships
Relationships that blossom into  friendships can be especially challenging to engage in for people of all ages who  happen to have disabilities. Relationships for people with disabilities are often limited to family members, paid staff  and other people with disabilities. These relationships may be the most critical and meaningful to the individual, but  all people benefit greatly by a diversity of relationships.

Everyone needs friends!

People with friends are happier. People with friends are healthier. People with friends are safer.
*The Real Friends Project

There are many  ways to bring people with and without disabilities together to grow and nurture friendships. Here are a few ideas to build from:

»  Religious activities
»  Volunteer in the community
»  Clubs
»  Join a gym  or your  local YMCA
»  Political involvement
»  Adult education classes
»  Special  interest groups

»  Special  Olympics
»  Best Buddies
»  Sports-related events  and activities
»  Travel
»  Routinely visit  local establishments in your  community
»  Community theatre

Transition Information Fact Sheet No. 19 • April 2015

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

State Agency Resources

Department of Mental Health (DMH)
State agency providing services  to individuals with long-term or serious  mental illnesses. DMH offers inpatient and outpatient services, case management, skill development, and employment, residential, individual, and family support.
25 Staniford Street
Boston, MA 02114
617-626-8000
Website: www.mass.gov/dmh

Department of Public Health (DPH)  State agency serving all citizens of the Commonwealth. Provides supports related to care, education, prevention, quality assurance,
disease control, and research to promote healthy
individuals, families, and communities.
250 Washington Street, 6th  floor
Boston, MA 02108
617-624-6000
Website: www.mass.gov/dph

Department of Transitional  Assistance (DTA) State agency that administers a range  of public assistance programs across the Commonwealth. Areas of focus include emergency and
transitional assistance,  food stamps,  and
Supplemental Security Income (SSI).
600 Washington Street
Boston, MA 02111
1-877-382-2363
Website: www.mass.gov/dta

Disabled Persons Protection Commission (DPPC) State agency protecting adults with disabilities from abuse, neglect, and omission of care by investigation, oversight, public awareness,  and
prevention. Suspected abuse can be reported by
calling the hotline number below.
300 Granite Street, Suite 404
Braintree, MA 02184
1-888-822-0350 (Voice/TTY)
617-727-6465
Website: www.mass.gov/dppc

Massachusetts Commission for the Blind (MCB) State agency supporting optimal community participation and independence by providing vocational and social services  as well as financial
and medical assistance to Massachusetts
residents who  are legally blind.
600 Washington Street
Boston, MA 02111
617-727-5550
Website: www.mass.gov/mcb

Massachusetts Commission for the Deaf & Hard of Hearing (MCDHH)
State agency offering training, technology, case
management, social services,  interpreter support, and independent living support for deaf and
hard-of-hearing individuals.
600 Washington Street
Boston, MA 02111
617-740-1600 (Voice)
617-740-1700 (TTY)
617-326-7546 (Videophone) Website: www.mass.gov/mcdhh

Massachusetts Office  on Disability  (MOD) State agency providing advocacy, information, and referral. Focuses  on legal rights, accommodations, and accessibility to promote
dignity, opportunity, and self-determination.
1 Ashburton Place #1305
Boston, MA 02108
617-727-7440
Website: www.mass.gov/mod

Massachusetts Rehabilitation Commission (MRC) State agency promoting dignity for individuals with disabilities through employment, education, training, advocacy, assistive  technology, and
independent community living.
600 Washington Street
Boston, MA 02111
617-204-3600
Website: www.mass.gov/mrc

Transition Information Fact Sheet No. 20 • April 2015

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 21 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Residential  Alternatives

Adult Family Care/Adult Foster Care (AFC)

»  Adult Family Care (sometimes called  Adult Foster Care) is a Medicaid-funded residential program for individuals who  require assistance with one or more  activities of daily  living (such as bathing or eating) to be able to live safely  in their  home.  Each participant receives the assistance they  need with personal care and activities of daily  living.  AFC members may only  stay alone for up to three  hours  at a time.
»  The program is administered by an AFC provider agency,  and provides case management, nursing consultation, and a MassHealth tax-free stipend to the caregiver. AFC has two levels of stipend payment related to the assessed needs of the individual. Each caregiver is thoroughly prescreened and undergoes a Criminal Offender Record Information (CORI) check.
»  To quality for AFC, individuals must be 16 years of age or older,  eligible for MassHealth,  and willing to participate in the program. Caregivers must be at least 18 years of age and cannot be legal guardians.
»  Caregivers of Adult Family Care may be a parent, sibling, or an extended family member who  resides  in the biological family home.  Caregivers of Adult Foster Care (not family members) provide support in their  own residence.

Section 8 Housing Vouchers

»  Section 8 housing is a federal assistance program run through the U.S. Department of Housing and Urban
Development (HUD).  The program helps low-income Massachusetts residents pay for their  housing.
»  Section 8 rental vouchers help Massachusetts tenants pay their  rent. Two  types of vouchers assist with rent:

1)  Section 8 Tenant-based Vouchers: A qualified individual chooses his/her own  apartment. The apartment must be safe and clean, and the rent  a fair market value. The landlord must agree  to accept the requirements from HUD. Individuals usually  pay 30% of their  income for rent, and the Section 8 program pays the rest. If the individual moves,  the Section 8 rental assistance goes with them.
2)  Section 8 Project-based Affordable Housing Vouchers: An individual must live in a specific Section
8 subsidized housing unit. Individuals usually  pay 30% of their  rent, and Section 8 pays the rest. The voucher does not  go with the individual when  they  move.

HOW  TO APPLY:
»  You can apply at public housing agencies or approved regional nonprofit housing agencies at the age of 18.
Your  name will be placed on a waiting list, which varies from community to community and can be very  long
(eight to ten years).  Therefore, you should apply long  before you will need the voucher.
»  Apply in several  communities. Apply at the housing authority in your  town, and also to the HUD centralized housing list at section8listmass.org. Once you’ve submitted an application, it is important to notify the housing authority of any address  changes and to respond to housing communication in order to stay on the housing list.

Other Residential  Options

»  Using self-directed supports and a combination of resources, creative living arrangements can be achieved.
Some examples:

1)  Renting or leasing:  Most communities have market rent  or subsidized apartments available. Information can be obtained from state agencies,  housing organizations, human  service  agencies,  friends, relatives, landlords, and realtors.
2)  Home  sharing:  Two  or more  unrelated persons sharing housing and expenses.
3)  Home, condo, or apartment ownership: Can be financed with family savings, investments, first-time home ownership programs, or special  needs trusts. In-home supports may be provided through a health care agency,  the Department of Developmental Services  (DDS), a roommate, or community and family supports.
4)  Collaboration with the local housing authority and provider agency.
5)  In-law  apartment with separate entrance/exit and cooking/bath facilities.

Consider continuing dialogue with DDS around creative partnership ideas and options, keeping in mind  the cost of long-term staffing needs.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 22 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

DDS Home & Community-Based
Waiver Overview

WHAT  are the Home and Community-Based Services Adult Waivers?
The Department of Developmental Services  (DDS)  Home  and Community-Based Services  (HCBS)  Waivers are a way for individuals to receive services  in their  home  community instead of an institution. These waivers are a federal and state partnership. They are run by DDS on behalf of the Commonwealth of Massachusetts through MassHealth (Medicaid). Federal reimbursement to the Commonwealth of Massachusetts for waiver services helps support the availability and expansion of DDS supports. The waivers may provide participants some level of protection of their  services.

WHO  is eligible  for HCBS Waivers?
To be eligible for the waiver program, you must meet  these federal requirements:

»  Apply to become a waiver participant;
»  Be a person with an intellectual disability as determined by DDS;
»  Be eligible for and enrolled in the correct MassHealth category;
»  Be at least 22 years of age;
»  Be eligible for admission to an Intermediate Care Facility for Individuals with an Intellectual Disability
(ICF/ID);
»  Agree to receive services  in the community rather than an institution; and
»  Be assessed by DDS to need one or more  waiver services.

HOW  can I apply?
In order to apply,  you need to fill out  a waiver application. Your  DDS Area Office can help you and can discuss the timing of your  application. DDS will conduct an assessment of your  needs, assign you a priority for services, and send you a letter to let you know if you are eligible for one of the waiver programs.

WHEN  enrolled  in one of the DDS Adult Waivers,  can I still receive  other Medicaid services?
Yes, you can be enrolled in the waiver program and still receive other Medicaid program services  such as medical care, nursing care, home  health  aide services,  personal care attendant services,  and any other medically necessary service  that is available through the Medicaid Program State Plan.

WHAT  happens if I do not enroll or cannot enroll?
DDS will work with you and your  family to determine if you need to enroll  in the waiver program to obtain or keep services  from DDS and help you resolve waiver eligibility issues.

WHAT  if my needs change?
If your  needs change,  you will be referred for an assessment to determine if you need additional or different services.  This may result  in eligibility for and enrollment in a different waiver.

WHAT  services can I receive  in the DDS Adult Waiver Programs?

INTENSIVE  SUPPORTS WAIVER PROGRAM
The Intensive  Supports Waiver Program provides services  for individuals with intellectual disability age 22 and older  with an intensive level of support needs, requiring supervision or support for 24 hours  a day, seven days per week, due to significant behavioral, medical, and/or physical support needs and the absence  of available, natural, generic, and Medicaid services.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 22 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Waiver services  offered include:
Adult Companion, Assistive Technology, Behavioral Supports and Consultation, Center-Based Day Supports, Chore, Community-Based Day Supports, Day Habilitation Supplement, Family Training, Group  Supported Employment, Home  Modification and Adaptations, Individual Goods and Services,  Individualized Day Supports, Individualized Home  Supports, Individual Supported Employment, Live-In Caregiver, Occupational Therapy, Peer Supports, Physical Therapy, Residential Habilitation, Respite,  Specialized Medical Equipment and Supplies, Speech Therapy, Stabilization, Transitional Assistance Services,  Transportation, Vehicle Modification and 24-Hour Self-Directed Home  Sharing.

COMMUNITY LIVING  WAIVER PROGRAM
The Community Living Waiver Program is for individuals who  can live in their  family home,  in the home  of someone else, or their  own  home,  and do not  need supervision 24 hours  a day, seven days a week  due to the combination of natural, generic, and Medicaid services.

Waiver services  offered include:

Adult Companion, Assistive Technology, Behavioral Supports and Consultation, Center-Based Day Supports, Chore, Community-Based Day Supports, Day Habilitation Supplement, Family Training, Group  Supported Employment, Home  Modification and Adaptations, Individual Goods and Services,  Individualized Day Supports, Individualized Home  Supports, Individual Supported Employment, Live-In Caregiver, Occupational Therapy, Peer Supports, Physical Therapy, Respite,  Specialized Medical Equipment and Supplies,  Speech  Therapy, Stabilization, Transportation and Vehicle Modification

ADULT SUPPORTS WAIVER PROGRAM
The Adult Supports Waiver Program is for individuals who  can live in their  own  home  or apartment or family home  due to the combination of strong natural/informal generic and Medicaid services.

Waiver services  offered include:

Adult Companion, Assistive Technology, Behavioral Supports and Consultation, Center-Based Day Supports, Chore, Community-Based Day Supports, Day Habilitation Supplement, Family Training, Group  Supported Employment, Home  Modification and Adaptations, Individual Goods and Services,  Individualized Day Supports, Individualized Home  Supports, Individual Supported Employment, Occupational Therapy, Peer Supports, Physical  Therapy, Respite, Specialized Medical Equipment and Supplies,  Speech  Therapy, Stabilization, Transportation and Vehicle Modification

HOW  can I find out more about the DDS waiver  program?
Your  DDS Area Office can provide you with additional information about the services  offered through the waiver program. You can also email the Waiver Management Unit at DDS-DL- WaiverManagementUnit@MassMail.State.MA.US or visit  the DDS website at www.mass.gov/dds.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 23 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

Age of Majority,  Guardianship, and Alternatives

Every  young person turning 18 has reached the age of majority and is considered an adult with the rights and responsibilities that come  with it. For young people with disabilities approaching this milestone, it is a time  to consider how  best to support them  in their  decision-making.
Every  person with disabilities does not  need a guardian. Guardianship should not  be used to protect the person from normal daily  risks we all face in working, having a home,  moving about, being consumers, and relating with other people. A guardian should not  be appointed simply because  the person has made (or is about to make) decisions that may be incorrect or show  poor judgment, or because  the person relies heavily on others for advice.

Alternatives to Guardianship

ADVICE
Some individuals can benefit from family members or other trusted advisors helping them  make decisions. Questions to consider are whether an individual has people available to assist him/her; whether the people from whom he/she is likely  to seek advice are likely  to give  sound  advice; and whether the individual is likely  to listen to, consider, and follow the advice.

EDUCATION
It is important to educate the individual not  only  on the areas in which he/she needs assistance,  but  also on how  to make good decisions once he/she has the relevant information. Education can be specifically directed at a troublesome area, or can be used in a limited fashion in assisting with one particular decision.

INFORMED  CONSENT
Informed consent is the agreement given  voluntarily by an individual who  understands and weighs
the risks and benefits involved in a particular decision. An adult over  the age of 18 is presumed legally competent to provide consent. According to Department of Developmental Services  regulations, whenever informed consent is required (prior to admission to a facility, prior to medical treatment, prior to being involved in research activities, prior to release of personal information, or before moving to
an alternative program option), the information must be provided in simple  ways. This ensures  that the individual has time  to ask questions and consider options. There must be agreement that the individual understood the situation and made  a clear decision.

LEGAL ADVOCACY
For many  decisions, the advice and advocacy of an attorney may assist the individual in reaching a good conclusion if the individual will listen to the advice and act accordingly.

DURABLE POWER OF ATTORNEY
If the individual is capable of executing this document, then  he/she can grant legal authority to another person to handle  certain specified affairs.  A Durable Power  of Attorney is usually  limited to financial issues, but  does not  have to be.

HEALTH CARE PROXY
An individual who  is capable of making health  care decisions may appoint a person,  called  a proxy, to make health  care decisions for him/her in the event  that he/she becomes incapacitated. The document to be executed may be as detailed as desired regarding guidance to the proxy. The involved physician must activate the health  care proxy based  on the individual’s decision-making capacity.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 23 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

REPRESENTATIVE  PAYEE
In the event  that an individual receives Social Security benefits (SSI or SSDI), these benefits may be managed by a person appointed by the Social Security Administration. This “representative payee” is required to make annual accountings to ensure  that the funds  are received and are being properly expended for the benefit of the individual.

Types of Guardianship

GUARDIANSHIP
Guardianship is an option for a person who  is deemed by the court to be incapable of making decisions about personal and financial affairs.  The clinical team evaluation is presented to the judge,  who  makes the decision to appoint a guardian. The judge has the ability to limit the guardianship, having the individual retain certain rights and abilities. Examples may include the right to vote,  to obtain a driver’s license, to choose  people for friendships and visitation, and to use a telephone or computer.

CONSERVATORSHIP
If the individual is not  competent to handle  financial affairs,  and there  is income from sources other than benefit checks,  or if there  are assets that are not  adequately protected, and there  is some risk of loss if the individual continues to handle  his/her finances,  then  a judge may appoint a conservator. The judge may decide that the individual is capable of handling a small amount
of money, and can exempt that amount from the conservatorship (Massachusetts General  Laws
Chapter 201, Section 16B).

ROGER’S COURT MONITOR
This type of single-purpose guardianship applies to an individual who  is not  capable of understanding the reason  an antipsychotic medication is needed,  and is not  capable of grasping the personal risks and benefits. If the person can apply reason  and make informed choices,  he/ she has the legal right to either accept or reject antipsychotic medication (even if that choice is unwise).

SUBSTITUTED JUDGEMENT
Substituted judgment is used in cases when  extraordinary treatment is proposed for a person under  guardianship or a person who  is in need of guardianship. “Extraordinary” treatments generally are medical treatments that are particularly intrusive, risky, or restrictive. The probate court renders a “substituted judgment” for the individual, and approves the treatment plan.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 24 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

MassHealth Benefits

What  is MassHealth?
MassHealth is state-administered Medicaid-funded health  insurance. It provides comprehensive health insurance--or help in paying for private health  insurance--to Massachusetts children, families, seniors, and people with disabilities.
To be considered “disabled” for MassHealth eligibility, you must have one of the following:

»  a certification of legal blindness from the Massachusetts Commission for the Blind
»  a disability determination by the Social Security Administration
»  a disability determination by the Division of Medical Assisance  Disability Determination Unit

Types of Coverage:

MASSHEALTH STANDARD  health  insurance coverage is automatically provided to SSI recipients. This coverage type offers a full range  of health  care benefits. Young people who  are not  on SSI may apply separately for MassHealth Standard.
MASSHEALTH COMMONHEALTH is for adults,  young adults,  and children with disabilities who  are not eligible for MassHealth Standard. There is no income limit for MassHealth CommonHealth. If your  monthly income before taxes and deductions is above 100% of the federal poverty level, you may have to pay a premium,* or meet  a one-time-only deductible.
MASSHEALTH COMMONHEALTH FOR WORKING ADULTS covers adults ages 18 through 64 who  are over the income limit for MassHealth Standard but  meet  the same disability standards and work at least 40 hours  per month. CommonHealth covers most of the same benefits as the MassHealth Standard program. CommonHealth Working members pay a monthly premium* that increases  as their  income goes up. There are NO income or asset limits for the CommonHealth Working program.
MASSHEALTH/KAILEIGH MULLIGAN  allows  certain children with significant disabilities under  age 18 to live at home  with their  parents and have MassHealth eligibility determined without counting the income and assets of their  parents. This program ENDS at age 18. Other MassHealth programs must be applied for at age 18 to maintain coverage as a young adult.

How to Apply:
The application for MassHealth (formerly the Member Benefit Request or “MBR”) is now  called  the
“Application for Health  Coverage and Help Paying  Costs.” Applications can be obtained:

»  BY PHONE through the MassHealth Enrollment Center  at 1-888-665-9993 (TTY: 1-888-665-9997).
They will send you a MassHealth information booklet, application form, and any supplements. They will also answer  any questions you have about applying for MassHealth.
»  ONLINE  at http://www.mass.gov/eohhs/docs/masshealth/membappforms/aca-2-english.pdf.

»  IN PERSON at a local community health  center, hospital, or other MassHealth-approved community organization. A MassHealth benefits advisor will answer  your  questions, fill out  an online  application with you, and submit your  application via computer. To find  a community health  center near you, call the Massachusetts League  of Community Health  Centers  Patient Referral Line at 1-800-475-8455.

To apply and be considered for MassHealth due to a disability, rather than income, either a CHILD DISABILITY SUPPLEMENT or ADULT DISABILITY SUPPLEMENT form must be included with the application.
An AUTHORIZED REPRESENTATIVE  DESIGNATION FORM must be submitted to MassHealth when submitting an application or to check  on eligibility, status  of claims, supplies, etc. on behalf of an adult child (over 18 regardless of ability/disability). This form will allow  information to be shared  about the adult child. The authorization may need to be renewed periodically.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 24 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

What  other benefits  may be available?

In addition to a full range  of health  care needs, MassHealth offers services  to eligible members for home  health  aides, personal care attendants, behavioral health  (mental health  and substance abuse) services,  incontinence supplies (diapers/pull-up briefs), transportation services  to medical appointments, adult family/foster care, adult day habilitation services,
and pharmacy services,  including coverage for prescription and over-the-counter drugs.  For more  information, go to www.mass.gov/masshealth/disability, or call 1-800-841-2900 or the Community Support Line at 1-800-882-1435.

Other benefits  to consider:

*The MASSHEALTH STANDARD/COMMONHEALTH PREMIUM ASSISTANCE (MSCPA)  program may pay some or all of you/your family’s private health  insurance premium or COBRA payment. The private insurance must meet  the Basic Benefit Level of coverage as determined by MassHealth and MSCPA. MSCPA (premium assistance) will continue for as long  as private health  insurance is retained for the member with a disability, and as long  as the member is eligible for MassHealth.  Premium assistance is a separate application process and must be applied for by calling the MSCPA program at 1-800-862-4840.

As a young adult with private health  insurance approaches the age of 26, an “Adult Dependent with a Disability” request should be considered and formally requested through the private health  insurance. This request, if approved, will ensure  that private insurance coverage continues past the current legally mandated age of 26.

As long  as the private health  insurance is maintained as primary insurance and MassHealth is secondary, eligibility for premium assistance (MSCPA)  should be retained, regardless of age. Contact MSCPA to request an application at 1-800-862-4840.

For further information regarding MassHealth benefits, visit  the Division of Medical Assistance website at www.mass.gov/dma, or call 1-800-841-2900.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

Transition Information Fact Sheet No. 25 • April 2015

TRANSITION  INFORMATION  EVERY FAMILY  SHOULD KNOW

SSI Benefits

There are different types of benefits provided by the Social Security Administration (SSA). These federal programs provide assistance to adults and children with disabilities, and to people who  have reached retirement age.
»  SUPPLEMENTAL SECURITY INCOME (SSI) pays benefits to adults and children with disabilities who  have limited income and resources and meet  medical disability criteria.
»  SOCIAL SECURITY DISABILITY INCOME (SSDI)  is for people who  have been in the workforce and have accrued Social Security credits and have a disability; or a child  with disabilities whose  eligible parent is retired, deceased, or has disabilities.
»  SOCIAL SECURITY is for people who  have reached retirement age.

Who is eligible  for SSI?

A young adult may qualify for SSI benefits if he or she 1) has disabilities, 2) has low  income, 3) has resources or assets LESS THAN $2000, AND 4) earns less than $1,000 per month (this  earning requirement does not  apply to those  who  are blind).
At age 18, an individual can apply for SSI independent of the parents’ income and resources. Many individuals with disabilities who  were  ineligible for SSI due to their  parents’ income and/or resources prior to age 18 may be eligible upon  their  18th birthday. However, SSI eligibility does not  happen automatically even if the individual was eligible as a child.

How do I apply for SSI?

An application for benefits can be obtained at the local Social Security office. SSI does not  have an online application, but  most individuals over  18 can start the process online  by reviewing the ADULT DISABILITY CHECKLIST and the ONLINE  DISABILITY BENEFIT APPLICATION To assist in gathering the information and documents needed to apply.
Schedule an appointment with your  local Social Security office or call 1-800-772-1213 (TTY 1-800-
325-0778) to make a telephone or local office appointment. Original documents, not  photocopies, are required for birth certificates and other documents. Bring  and share original documents during your visit,  but  only  leave copies,  and ask for a receipt for all documents provided to SSA. This helps to maintain progress in the application process.

How much will I receive?

The amount you receive depends upon  your  living arrangement and employment status.  Although SSA
does not  count the income and assets of parents to determine the financial eligibility of individuals ages
18 and over, living with parents or others may affect the amount of the SSI benefit.

The STATE SUPPLEMENT PROGRAM (SSP) in Massachusetts provides an additional supplement to the federal SSI cash assistance program through a separate payment. If you are blind and have another disability, you will receive a higher benefit through the SSP.

What  other benefits  will I get?

»  HEALTH INSURANCE: If you are determined eligible for SSI, you will automatically be eligible for
MassHealth Standard health  care coverage. You do not  need to file a separate application.

»  SNAP FOOD STAMPS: SSI recipients usually  qualify for SNAP food stamps.  If you live in a household where everyone is applying for or receiving SSI, you may apply for SNAP food stamps at the Social Security office. Otherwise, you must apply at the Division of Transitional Assistance.
»  FUEL ASSISTANCE: SSI recipients may apply for fuel assistance during the heating season.

»  SSP SPECIAL BENEFITS: SSP Special  Benefits may pay for moving expenses  if you move  within

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES

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the state, or pay for replacement items if things you own  are destroyed in a natural disaster or fire. To apply,  contact the Department of Transitional Assistance.
»  BURIAL EXPENSES: You may receive up to $1,100 for burial expenses  for SSI recipients who  do not  have resources to pay toward these expenses.  The total cost of the burial cannot be greater than $1,500. No additional services  or payments can be obtained or provided above the $1,500 maximum burial expense,  regardless of payor.

Working and SSI

In certain cases, SSA does not  count some of your  income or resources. Certain incentive programs allow  you to continue to collect SSI cash benefits, or let you continue to receive Medicaid coverage even though you are not  receiving SSI cash benefits.
THE PLAN TO ACHIEVE SELF SUPPORT (PASS) is an SSI work incentive program that allows  a recipient to set aside income and resources to pay for education or training for the purpose of obtaining employment. The SSA will not  count the income that you set aside under  your  PASS when  they  figure out  your  SSI benefit payment amount. In order to be eligible for PASS, the SSI recipient must prepare the plan in writing. A form is available at the Social Security office.
THE IMPAIRMENT-RELATED WORK EXPENSES (IRWE) program allows  people with disabilities who  are out  of school and seeking employment to exclude certain costs  from their  gross income. Expenses  such as the cost of job coaching may also be applied to reduce income in order to maximize the SSI benefit payment amount.
THE STUDENT EARNED INCOME EXCLUSION  is a work incentive that allows  qualified young people who  are still in school to keep some or all of their  earnings without losing  money from their  SSI checks.
BENEPLAN and PROJECT IMPACT can provide additional information about how  working and earning or increasing wages  impacts SSDI and/or SSI benefits. Which program you can access depends on where you live.
BenePLAN assists consumers and staff  of state agencies,  employment provider organizations, and school systems in these Massachusetts counties: Essex, Norfolk, Middlesex, Worcester, Hampden, Hampshire, Franklin, and Berkshire. BenePLAN can be reached at 1-877-YES WORK (1-877-937-9675) or online  at www.BenePLAN.org.
Project IMPACT provides individualized benefits counseling to Massachusetts Rehabilitation Commission consumers, and to their  family members, employment provider organizations, school systems, and state agencies in Suffolk, Plymouth, Bristol, Barnstable, Nantucket, and Dukes counties. Project IMPACT can be reached at 1-800-734-7475 or 617-204-3854, or at 617-
204-3834 (TTY).

For more  information, visit  www.socialsecurity.gov/work or your  local Social Security office.

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Special Needs Trusts

What  is a Special Needs Trust?

A Special  Needs Trust is a fund  set up to provide additional funds  for an individual with a disability.
When  drafted and administered properly, a Special  Needs Trust will allow  the beneficiary to benefit from the trust while  retaining eligibility for public benefits and maintaining the current amount of benefits being received. A Special  Needs Trust may be created using  assets of the beneficiary (the  person with the disability) or funds  from a family member. One does not  have to be wealthy to create or have a Special  Needs Trust.
Special  Needs Trusts  are designed to set aside funds  for personal needs, and do not  affect government benefits that are critical to individuals with disabilities, such as:
»  Supplemental Security Income (SSI)
»  Medicaid
»  Section 8 Housing
»  Food  Stamps

Why Create  a Special Needs Trust?

A person must have very  few assets to be eligible to receive government benefits. For example, the
2008 SSI eligibility maximum is $2000 for a single  person and $3000 for a married person,  subject
to certain exclusions for some personal assets. The creation of a Special  Needs Trust allows  additional funds  for an individual to meet  personal expenses.  The trust needs to be irrevocable, and the beneficiary must not  have the power to direct the use of trust assets for his or her own  support.

What  Is a Special Needs Trust Used For?

Trust assets should be used to provide goods and services  beyond those  provided by public benefits programs, such as entertainment, bus passes, household goods, education, medical costs  not  covered by other benefits, and medical equipment.

Other Suggestions

Speak with an attorney who  specializes in estate planning for individuals with disabilities or elder  law if you have questions about whether you or a loved  one may benefit from a Special  Needs Trust.
Special  Needs Trusts are complex and must be drafted and administered very carefully. Make sure that the Special  Needs Trust is drafted by an attorney skilled  in this specialty.
Communicate your  plans with siblings and future caregivers of the individual with disabilities.
Accept monetary gifts from grandparents and other relatives, but  make certain that gifts are directed to the Special  Needs Trust.

MASSACHUSETTS  DEPARTMENT   OF DEVELOPMENTAL   SERVICES