Trend Graph Index

• Term 32 – Crisis Assessments in Community Settings
• Term 35 – Community Residence Identified Within 30 Days
• Term 50 – Waiver Employment Target
• Term 51 – Overall DD Employment Target
• Term 37 – Integrated Day Services
• Term 38 – Private Duty Nursing Utilization
• Term 39 – Skilled Nursing Utilization
• Term 40 – Annual Dental Exams
• Term 54 – Annual Physical Exams
• Term 33 – Therapeutic Consultation Timeliness
• Term 34 – Behavioral Support Services
• Term 43 – Waiver Slot Enrollment Timeliness

Permanent Injunction Requirements – Trend Graph Reporting

Pursuant to Permanent Injunction Term 67, the Commonwealth is required to maintain and regularly update public-facing information demonstrating how the developmental disability (DD) system is functioning. This includes data, reports,
and trend graphs that measure performance against specific requirements of the Order.

The Library includes statutes and regulations, policies and protocols, tools and checklists, manuals, guidance, reference materials, and data related to areas such as crisis services, employment, case management, integrated services, quality improvement, and risk management. Information is updated on a regular basis in accordance with the Order.

Required Trend Graphs

As required by Term 67(j), the Commonwealth publishes trend graphs updated no less than semi-annually for the following performance measures:

• • Percentage of crisis assessments conducted in community settings (Term 32)
  • Percentage of individuals admitted to a Crisis Therapeutic Home (CTH) or psychiatric hospital with a community residence identified within 30 days (Term 35)
  • Percentage to waiver employment target (Term 50)
  • Percentage to overall DD employment target (Term 51)
  • Percentage of individuals on the DD waiver receiving day services in the most integrated settings (Term 37)
  • Private duty nursing utilization (Term 38)
  • Skilled nursing utilization (Term 39)
  • Percentage of individuals in residential settings who receive an annual dental exam (Term 40)
  • Percentage of individuals in residential settings who receive an annual physical exam (Term 54)
  • Percentage of individuals referred for Therapeutic Consultation with a provider identified within 30 days (Term 33)
  • Percentage of individuals with identified behavioral support needs receiving adequate behavioral services (Term 34)
  • Percentage of individuals enrolled in a service within five months of waiver slot assignment (Term 43)

Crisis Assessments in Community Settings (Term 32)

Goal: The Commonwealth will work to achieve a goal that 86% of children and adults receive crisis assessments at home, the residential setting, or other community setting (non-hospital/non-CSB office). Crisis Receiving Centers (“CRC”) will only be counted as an “other community setting” after it is determined that the individual or supported decision maker was not directed by the Call Center, Emergency Services, or Mobile Crisis staff to present at a CRC.

Figure: PI 32 performance over time toward the 86% target (Updated January 2026)

Community Residence Identified Within 30 Days (Term 35)

Goal: The Commonwealth will work to achieve a goal of 86% of individuals with a DD waiver and known to the REACH system who are admitted to a CTH or a psychiatric hospital have a community residence identified within 30 days of admission.

Figure: PI 35 performance over time toward the 86% target (Updated January 2026)

Waiver Employment Target (Term 50)

Goal: The Commonwealth will work to achieve a goal of being within 10% of the waiver employment targets set by the Employment First Advisory Group. DBHDS will continue to work with the Employment First Advisory Group, the Quality Improvement Committee (QIC), and the QIC subcommittees to develop and recommend QIIs to enhance employment of adults aged 18-64 on the DD waiver. If the goal is not met within two years of the date of this Order, DBHDS will conduct a root cause analysis and implement a QII. DBHDS will continue this quality improvement process until the goal is achieved and sustained for one year.

Figure: PI 50 performance over time toward the 90% target (Updated January 2026)

Overall DD Employment Target (Term 51)

Goal: The Commonwealth will work to achieve a goal of meeting its established employment target of 25% for adults aged 18 to 64 on DD waivers and the waitlist. DBHDS will continue to work with the Employment First Advisory Group, the QIC, and the QIC subcommittees to develop and recommend QIIs to enhance employment of adults aged 18 to 64 on the DD waiver and the waitlist. If the goal is not met within two years of the date of this Order, DBHDS will conduct a root cause analysis and implement a QII. DBHDS will continue this quality improvement process until the goal is achieved and sustained for one year.

Figure: PI 51 performance over time toward the 25% target (Updated November 2025)

Integrated Day Services (Term 37)

Goal: The Commonwealth will work to achieve a goal of a 2% annual increase in the percentage of individuals on the DD waiver receiving day services in the most integrated settings.

Figure: PI 37 performance over time toward the 2% target (Updated November 2025)

Private Duty Nursing Utilization (Term 38)

Goal: The Commonwealth will work to achieve a goal that 70% of individuals on the DD waiver and children with DD receiving EPSDT with private duty nursing identified in their ISP or prescribed under EPSDT receive 80% of the hours identified as needed on the CMS485 or DMAS62 forms.

Figure: PI 38 performance over time toward the 70% target (Updated October 2025)

Skilled Nursing Utilization (Term 39)

Goal: The Commonwealth will work to achieve a goal that 70% of individuals on the DD waiver and children with DD receiving EPSDT with skilled nursing identified in their ISPs or prescribed under EPSDT will have their skilled nursing needs met 80% of the time.

Figure: PI 39 performance over time toward the 70% target (Updated October 2025)

Annual Dental Exams (Term 40)

Goal: The Commonwealth will work to achieve a goal that 86% of individuals who are supported in residential settings and have coverage for dental services will receive an annual dental exam.

Figure: PI 40 performance over time toward the 86% target (Updated October 2025)

Annual Physical Exams (Term 54)

Goal: The Commonwealth will work to achieve a goal that 86% of individuals supported in residential settings receive annual physical exams.

Figure: PI 54 performance over time toward the 86% target (Updated October 2025)

Therapeutic Consultation Timeliness (Term 33)

Goal: The Commonwealth will work to achieve a goal that 86% of individuals identified as in need of Therapeutic Consultation service are referred for the service and have a provider identified within 30 days.

Figure: PI 33 performance over time toward the 86% target (Updated November 2025)

Behavioral Support Services (Term 34)

Goal: The Commonwealth will work to achieve a goal that 86% of individuals with identified behavioral support needs are provided adequate and appropriately delivered behavioral support services.

Figure: PI 34 performance over time toward the 86% target (Updated November 2025)

Waiver Slot Enrollment Timeliness (Term 43)

Goal: The Commonwealth will work to achieve a goal that 86% of individuals who are assigned a waiver slot will be enrolled in a service within five months.

Figure: PI 43 performance over time toward the 86% target (Updated November 2025)