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Official Minutes
July 28, 2006

Staley Implementation Group

Resource Connections of Oregon
Salem, Oregon 97305

In Attendance: Cynthia Owens, Marcela Tafalla, Kathryn Weit, Cindy Helvington, Judy Cunio, Arlene Jones, Marcie Ingledue, Mary Anne Seaton, Caryl Knudsen, Bev Herrin, Tim Kral, Margaret Theisen, Mary Lee Fay, Kim Sellman, Jim Wrigley, Dan Peccia, Mike Maley, Martha Stracener, JoAnne Fuhrman, Tom Racioppo, Janet Stevely , Sandra Stewart.

Meeting was called to order by facilitator, Caryl Knudsen at 9:40 AM.

Introductions and Announcements

Introductions were made. Kathryn Weit announced that Charlene Dean sustained a fall resulting in a fractured hip. A get well card will be circulated for SIG members to sign and be mailed to Charlene.

Review & Approval of Minutes

Judy Cunio motioned and Dan Peccia seconded approval of the May 24, 2006, minutes. Minutes were approved.

Monitoring/Updates

Brokerages

Fiscal Intermediary (FI) overview presentation had not been discussed at the recent brokerage directors’ meeting, so no date has been set at this time with regard to a FI overview presentation by brokerages. Announcement was made that brokerage Executive Director, Larry Deal, has resigned from DSI.

Counties

No county representatives were present. The State will meet with county DD managers and to rectify this situation.

Customer/Family/Advocates

Cynthia Owens announced that new transition training will be occurring over the next 3 years through Oregon Parent Training and Information (OrPTI). Representatives from the brokerages are encouraged to attend.

Judy announced that Self Advocates As Leaders (SAAL) will be doing training workshops in several counties. Information on the trainings will be sent out. Marcie Tafalla can be contacted for event flyers.

Providers

Oregon Rehabilitation Association (ORA) was awarded funding for their proposal on benefits planning and consultation for individuals in SILP who will transfer to supported living or supported services. Janet Steveley will be hired to look at how to do the benefits planning. Question was raised as to whether there would be creation of simple fact sheets. It was explained that part of the Request for Proposal (RFP) involves development of customer friendly tools by Janet. Activities should give Individual Support Plan (ISP) teams materials and tools to make best decisions. There is also focus on higher priority individuals for benefits planning and subsequent analysis and evaluations. Margaret Theisen mentioned that the Oregon Community Foundation is interested in capacity development for benefits planning especially in rural areas. Martha Stracener related on her experiences in development and conduction of trainings on benefits planning in the state of Alaska.

Tim Kral related two incidents with regard to funds in providing supported employment being money-losing areas for providers. Kathryn recommended that employment for brokerage customers be an agenda item for discussion at a future SIG meeting. Questions were raised as to whether there were differences in between the comprehensive and brokerage systems, and whether Medicaid Management Information System (MMIS) would be able to give tracking information in regard to rates. State replied that it was probably too early for meaningful information to be available.

SPD Update

• Data report: Enrollment/trends, etc—Over the past 2-3 years, the consistent observation has been the predominance of individuals entering through Family Support /Childrens In-Home Support Transition and High School Transition. With the projected doubling of individuals entering into the brokerage in the future, the distribution may reflect higher numbers from the General Adult Wait List.

Questions were raised with regard to the 2007-2009 biennium in consideration of (1) whether there would be backfill, (2) would there be better ways to eliminate the refused services number through better screening as these end up being lost slots. Reasons for individuals refusing services appear to be due either to issues which can not be screened for, or in some instances appear to be county specific. In those county specific instances, the individual brokerages have been approached with increased education.

• Comp 300: Status—11 individuals are poised to enter into brokerage services (southern Oregon region). A letter had been sent out by the Staley Oversight Committee to the State expressing concerns by the plaintiffs as to the inclusion of individuals, not living in their family homes, having equal access to non-crisis comprehensive services. Copies of the State’s response were distributed to the SIG, clarifying the confusion. The rule language would be amended such that in consideration of two individuals who were eligible for non-crisis comprehensive services, where one was living with their family and the other was living on their own, priority would be given to the individual living with their family.

• SILP transfer—The SPD staff is traveling around the state to give information. Molly Holsapple is moving over to the rate restructuring project.

• Roadmap training—Spanish translation of “A Roadmap To Support Services” manual has been completed, but the Microsoft Word formatting would require changing graphics. If the document is preferred in its entirety, then different software would be needed. Kathryn will continue discussion with Bill.

• Supported Employment Learning Network—is a collaborative effort involving Oregon (Mary Lee Fay) and 13 other states. Medicaid Infrastructure Grant (MIG) will pay for Oregon’s participation for the first year ($35,000). In the first call to states asking why they were interested, enthusiasm was great especially with regard to implementing systems change. Contractors will be coming to each state to do an assessment, with coordination occurring among the states in late August (University of Massachusetts, John Butterworth; Jean Keenan). As rate restructuring is examined, want to systemically find out what to do. In collecting protective services data, observation would be made for types of abuse allegations. Mike suggested the possibility of this type of information being presented at a future SIG meeting.

• MMIS—Continue as the current ongoing bottom line payment system, not increasing workload and therefore streamlining what brokerages have to do for reporting. EDS, the company that is undertaking the conversion, is accustomed to dealing with the medical portion of Medicaid and has now taking on waivers. They need to be educated and re-educated on the self-determination philosophy. This has been requiring State manpower, so the SIG was forewarned that turnaround time with regard to questions directed to the State on other items may be delayed. The fully operational system is projected to be on-line in the fall. Although it was felt that it is too early to talk about the training portion of the MMIS conversion, it is expected that intensive training will be occurring in January 2007.

• Grievance Workgroup—Janet Straw distributed drafts of (1) Notification of Planned Action, (2) Administrative Hearing Request, and (3) Policy proposal on signatures for support services ISP’s.
• Grievance—Notification of Planned Action—this would serve as a uniform, consistent statewide form to be used every time there would be a denial. The following recommendations were received in response to Janet’s request for feedback:
• More clearly label this form to avoid confusion with other Grievance/Fair hearing forms
• Area for a summary of the denied request be placed under of “Action and Reason for Action”
• Have “Oregon Administrative Rule(s)” follow “Action and Reason for Action”
• A cover letter accompany this form
• Training as to use of this form
• Bold the “10 days of benefits,” under “Part 2 – Continuing Your Benefits”
• Administrative Hearing Request—this is a form to request the hearing, which would be used department wide. The importance that adequate training goes along with use of these forms was stressed, to avoid confusion of individuals who would be receiving them.

• Policy Proposal on Signatures for Support Services Individual Support Plans—this was to address the small number of situations where obtaining signatures of the customer or the customer’s legal representative is problematic. Consensus approval for the first listed proposal (“amend the Support Services rule to allow for an “authorized designee” (AD) like the Independent Choices programs allow”) to be moved ahead and entered into the support services rule.

Top Strategic Priorities

Customer Questionnaire Survey—Margaret reported on the results of the Customer Questionnaire Survey. Its intent was to have expanded meaningful conversations with customers to obtain more information (2% statewide) to determine what people needed and wanted, and what was not available. 89 customers were interviewed by their Personal Agents, at the annual review of customers’ plans. So as to expedite the process, the activity was not necessarily a random selection at each of the brokerages. Material distributed represented approximately 5% of the information gathered. Data confirms impressions of the brokerages and anecdotal information. The material can be sorted by zip code.

Some of the information gained and lessons learned included:

• Need for more education with regard to employment—gets at some of the questions related to money and friends
• Supports the impression of high involvement of family members
• In spite of the amount of work required to conduct the survey, benchmarking and qualitative information was gathered
• It is good to conduct these personal meaningful conversations
• In the future, prioritization and focus on one topic, with guidance and connection to SIG prioritized Personal Outcomes statements was recommended

Next steps—brokerage directors to look at SIG suggestions and at the Personal Outcomes statements. Taking into consideration the brokerage workload, it may be possible to remeasure in a year or on an annual basis.

Other Strategic Discussions

• Fiscal Intermediary/Employer Agent Overview

Mike related information to frame a more in depth discussion of issues that the brokerages are facing. Funds can not be given directly to customers; services need to be paid for on their behalf. Brokerage development involved adoption of 7 core functions with fiscal intermediary (FI) being one of those functions. Employer-Agent piece incurred the most difficulty. This is the scenario which occurs when a customer or customer’s representative says that as part of the services requested, he/she wants to hire an employee and self-direct that. Then the brokerage says that they will become the employer-agent. IRS ruling 80-4 states that an employer can have an agent.

• Estimates of people involved (?)
• Laws allow for what brokerages are doing, but there are still IRS regional offices that do not understand the rule, and there some answers which are not clear
• Assumes that the customer/family knows how to do FI
• Assumes that the customer/family wants to do FI.

Sue Flanagan has put together a very procedurally (90 steps) bound document that states what the IRS has to do.

In the use of the Agency with Choice it is foreseen that this could cut into the number of actual hours that could be paid for by different customers. It is roughly estimated that use of the Agency with Choice would add $9.00 above the provider rate, resulting in a decrease in the number of actual hours by half. Discussion followed with suggestions of possibly setting a flat fee depending on longstanding relationships, or a onetime sign-on fee, so as to reduce the hourly cost.

Question was raised as to actual use of this program. According to Dan Peccia, this program has been used by only one customer in Washington County. Cynthia Owens raised the issue of insurance benefits. A workgroup consisting of Margaret Theisen, Bev Herrin, JoAnne Fuhrman, Marcie Ingledue, and Dan Peccia, will look at issues around Agency with Choice. Suggestion was made that Sue Flanagan be contacted to present other models and options that may be available for exploration. Agency with Choice would still be offered as an option. Mary Anne Seaton stated that this could be a good question to ask as she goes around the state talking with Comp 300 families. Suggestion was made that the group may want to reach out to those who want to engage in doing this as providers. Dan will contact individuals he is familiar with.

Retreat Committees Reports

• Training Committee—The Roadmap Workgroup is continuing to work on training materials and has a presentation scheduled for the October 19, 2006, Washington County Developmental Disabilities Resource Fair on a portion of “A Roadmap to Support Services” manual. Power points are currently being developed by Ann Blackburn and Wendy Taliaferro. This opportunity would serve as a testing site for material. Another presentation opportunity will occur May 15 or 16, 2007, at the OrPTI high school transition conference within a brokerage/employment track. The possibility of DVD/CD ROM and website application of training is also being explored by the group.

Question was raised as to the development of a Trainings list. The Region 1 Coop Trainings are listed on the SDRI website for the Metro area. Mary Anne is interested in a systemwide analysis of trainings—who is doing it and where can you go. Workgroup interested in trainings to providers would include Cynthia Owens, Marcie Ingledue, JoAnne Fuhrman, and Cindy Helvington.

• Conflict of Interest—Further feedback was not received from brokerages with regard to conflicts of interest policy statements, examples, and stories. Kathryn recommended that the SIG refer the drafted statement to the State and work with the brokerages to move this forward, as the brokerages were best able to deal with conflicts of interest, and the State had the best knowledge of rules. Motion was made to have this go forward to the State. Approval was by consensus.

• Caseload Ratio Workgroup—The previous focus of the workgroup on amount of time PA’s were spending on customer paperwork has shifted. The workgroup re-examined the retreat notes and original assumptions. DSI’s PA survey results, which provide a snapshot, had been presented to the workgroup by Larry Deal. It was felt that if a few other brokerages could conduct the study, the data could be used as a baseline. PA’s are doing a lot of things that Medicaid can not pay providers for. Examples given included PA’s spending time to help customers move since customers who don’t have family but need to move; visiting a customer in the hospital; paperwork, car time; individuals who are being referred to the brokerage with no family or friends and are also experiencing behavioral or relationship issues that end up involving a lot of PA time. Another meeting has been set by the workgroup. Suggestion was made that the notes be sent to the SIG electronically. Caryl Knudsen will make that request of Larry.

Review Meeting and Plan Next Meeting

• Next meeting is scheduled for Thursday, October 5, 2006 at Resource Connections of Oregon in Salem.

• Identify agenda items
• Employment for brokerage customers
• Infrastructures of trainings that support Staley Support Services
• Brokerage expansion

Adjournment

The meeting was adjourned.

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