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Official Minutes
Resource Connections of Oregon
Salem, Oregon 97305
June 22, 2007
- Next meeting is scheduled for Friday, September 28, 2007, at Resource Connections of Oregon in Salem from 9:30am – 3:00pm. The Customer/Family/Advocate group will meet from 8:30am – 9:30am.
- Remaining meeting for 2007 will be held on November 30, 2007.
In Attendance: Cynthia Owens, Judy Cunio, Cindy Helvington, Carol Simonds, Arlene Jones, Marcie Ingledue, Pam Ring, Joe Carroll, Nona Scott, Bill Lynch, Dianne Duerscheidt, Bev Herrin, Caryl Knudsen, Pat Allen-Sleeman, JoAnne Fuhrman, Dawn Anderson, Jim Wrigley, Mary Lee Faye, Kathryn Weit, Tim Kral
Meeting was called to order by facilitator, Bill Lynch, at 9:40am.
Introductions and Announcements
Introductions were made.
Review & Approval of Minutes
It was moved and seconded that the March 23, 2007 minutes be approved with the following corrections—addition of Nona Scott to the attendee list, and amending the statement under Data report: Enrollment/trends, etc, “Information on the 8-21 yrs data…” should read “Information on the 18-21 yrs data...” Corrections will be made with the final version to be posted on the Arc of Oregon website.
Review & Approval of Agenda
Amend the agenda to read “Change Review/Approve March 2007 minutes,” and include “Role of the SIG” discussion after lunch.
Monitoring/Updates
SPD Update
- Data Report: Enrollment/trends, etc., including data on reason for enrollment of 18-21 years old and which brokerages serve them
Individuals (all ages) enrolled in case management data will help with identifying future needs. Quarterly, the new case entries will be looked at. At this point “new” refers to new people requesting services. Further clarification is foreseen with determining what is meant by new—may consider those re-enrolling, who had previously been in the system, but exited in the past, or those who have moved from another county. The data will be used to better project the numbers of who will be entering into support services in the years to come. The information will be reflected in county service coordination reports.
Question was raised as to whether an increase in people “coming out of the woodwork,” is expected with the waitlist disappearing. Yes, this has actually been occurring over the past year, with 4.9% new entries in the last year; 13% went into case management.
Enrollment and Termination Summary—Bev Herrin noted that only brokerages with 450 or less showed the lowest percentage termination. Smaller the brokerage, the smaller the percentage termination—does this have a significance, ie.—reflection on better customer service? Unknown. At this point, the increased number of enrollments will be seen from high school transition, crisis, and the general waitlist.
Enrollment of 18-21 year olds into Support Services Brokerages Summary—The data reflects information pre-2006, as it does not contain information beyond 2006. The future county data collection should better indicate growth numbers.
Currently, waiting for the Human Services budget to go through the legislature, notation was made of DD provider wages, and “still more for DD provider wages.” Overall, results of the legislature and budget are positive, with continuing services, added COLA, addition of new brokerages, cost of services increase. These are in addition to the policy packages (Medicaid Waiver for Medically-Involved Children, Provider package). It was noted that although this reflects a 17% increase in budget, other areas received 22%.
- CMS Audit Report and Implementation of Recommendations
Dawn Andersson reported that the Centers for Medicare and Medicaid Services (CMS) audit final report has been received and the response was favorable. CMS revised its determination on “grievance” from “unmet” to “partially met” for both supports services and comprehensive waivers. Response is expected back on a Corrective Action Plan which was sent to CMS. Contained in the plan is a training schedule for grievance and hearing rights (notification and notification/complaint forms, usable for self-advocates). Due to manpower availability, trainings are pending completion of the SIS (which should end September/October 2007). The trainings are specific around information on grievance, forms to be used, and are to be conducted annually. Question was raised as to whether this included a rule change, with the response being “no,” as it was already in rule, but this activities will help with clarification. It is expected that QA Coordinators will visit County Developmental Disability Program (CDDP) sites. It is also hoped that QA Coordinators would visit the brokerages to identify if there are statewide issues being seen on a case by case basis.
With regard to the Level of Care form, CMS had evaluated the revised form and made recommendations. A pilot will be done requiring face to face meeting with the customer, conducted by the PA versus county service coordinator. It had been noted that more often the PA had the most knowledge about a customer’s level of care versus the county service coordinator. On the Comprehensive side, this would have to be done face to face and a connection made on the Individual Support Plan (ISP).
Panels reviewed new brokerage RFP’s. Five respondents in Portland Metro region with Northwest Connections (Larry Deal) awarded the contract; two respondents in the Mid-Valley, with DSI (Development Services Incorporated/Mentor/National Mentor Services) receiving the contract. Enrollments would begin in October 2007 (budget reshoot took this into account), with contracts in place as of July 2007.
With reference to DSI holding two brokerages, clarification was received that some level of guarantee through the written contract so that there would be two separate brokerage entities (maintaining the 750 customer cap) with each having separate executive directors and policy oversight groups. Not in violation of our rules.
Timeline and expectations considerations: State expressed that expansion of brokerage system to further meet needs after the roll-out period has not been developed yet, so that if there is a community which is interested in brokerage acquisition, now is the time to act (better planning and end up with brokerage that a community wants). Don’t want to wait for an RFP to show up, since that process is only 30-60 days.
- COLA Implementation for Brokerage Customer Plans
5.6% COLA will be instituted for DD148 and DD149 as of July 1, 2007. This amount can be looked at as a “make-up” COLA. Another 2.1% will be implemented in July 1, 2008. The COLA does not affect general businesses, whose rates are established elsewhere. Amendments are signed for customer plans, when each customer’s plan is renewed. Brokerages hope to have technical assistance from the Oregon Technical Assistance Corporation (OTAC).
Both in-home support services and comprehensive waivers would need to be amended each time the COLA is instituted. RCO was thanked for all the work staff had been doing to make implementation work.
In general, with regard to private pay customers, if a provider organization is providing services for both private pay customers and brokerage customers, then COLA is not being instituted for private pay customers—waiting to see fall-out. Question was raised as to whether the SIG should develop a policy and look at purchasing ability (what can you buy for services requested).
- Comp 300 and work group (review membership)
It had been proposed to have 130 individuals enrolled into Comp 300 in this biennium. In actuality, this number was 138, with individuals receiving ~$3200/month. As of this time, at total of 170 individuals have been enrolled into Comp 300, with the last 130 remaining for the next biennium. With regard to Comp 300 for the next biennium (07-09), the base budget is higher (better), so that the amount per individual is ~$6887/month (with the breakdown of $5530 $1104 $253).
Strategy for implementation will be the same as in the past biennium, with this year (2007) being the planning year (look at cohesive planning), and implementation July 2008—June 2009.
SIG Comp 300 Workgroup membership was reviewed. Workgroup is to discuss eligibility, regional planning, housing dollars, startup funds, how to portion funds, etc for this next roll-out. Meeting to be held on July 19, 2007, 9:00am – 11:00am at the Human Services Building in Salem.
- Discussion occurred as to including individuals (family members) who had presented a bill in the legislature on comprehensive services. Request was made that notes from each meeting come back to the SIG.
- Workgroup includes Kathryn Weit, Pat Allen-Sleeman or Carol Steadham, Judy Cunio, Marcie Ingledue, etc (as listed on two documents which were distributed. The 07-09 document was missing many names/representatives).
- Proposed Pilot Project Regarding County DD Programs and Plan Authorization
In this organized health delivery service, brokerages are able to authorize and spend Medicaid dollars; exploration is being done to amend the waiver so that plan authorization would occur at the brokerage level versus the county level. This would be a changing of roles, with the three year pilot occurring in Clackamas County. Implications—if plan authorization occurs at the brokerage level versus county level, could those county dollars (50:50 match) be used for other things, such as enrollment in and out, crisis, etc. Title XIX waiver authorization would still be at the County level, but not the plan of care (POC) authorization. (One brokerage relies on county QA as POC authorization.). Results will be reported to the SIG upon completion of the pilot. Once approval received from CMS, then measures will be identified.
Mary Lee reported that $15,000 of the general fund, is specific to supporting trainings for families. The funds would be available from July 4, 2007 onwards, and suggestion was made that funds go through the Arc of Oregon. If trainings were to include brokerages and PAs training, then Medicaid match would also be available. Suggestion was made as to whether some of the funds be used for development of a book as resource material between brokerages and school districts, as had been developed for brokerages and vocational rehabilitation (VR). This was brought up with regard to negative comments being received from school districts as their staff interface with brokerage PAs.
Workgroup was formed to further look into family/brokerage training needs, development of a master plan. Master plan would then be brought back to the SIG.
Workgroup—Cynthia Owens (convener), Marcie Ingledue, Bev Herrin, Arlene Jones, Kathryn Weit, Judy Cunio, Cindy Helvington, Dianne Duerscheidt
- Conflict of Interest Form
HSRI did a large report on support services (17 states are mentioned) for CMS. States and brokerages will look into use of the Conflict of Interest form that was developed in Oregon. Status of use of the form in Oregon will be set as follow-up agenda item for next time.
[Caryl Knudsen was thanked for her years of service, as she is retiring. Providers would continue endorsement of Caryl in her stakeholder position for a phase-out period.]
Discussions had occurred at the DD Coalition with regard to re-defining or clarifying the role of the SIG—are we having impact on decisions, what is working and what is not, as far as the brokerages, and what can be incorporated for comprehensive services.
- Review of the original assumptions and what is actually occurring
- It was noted that PAs are not doing resource capacity development, but are dealing with customers with complex mental health needs, court systems, etc.
- Fitting into a bigger system
- Where to bring together other agencies to look at issues, whose perspectives are not always expressed. Alternate with broader systems change meeting.
- Interface or role with the Comp system? Conflict of Interest form?
- Identification of issues and taking those to decision/closure—how to cross-over to Comp side
- Broader role of the SIG in the entire system—topic for DD Coalition
- Being accountable from subgroup (work group) to SIG group
- Suggestion made of creating a list of subgroups, so as to ease follow-up with each one
- How to loop back into discussions—ie.—school districts or families
- How to deal with anecdotal information/PA frustration and give assistance to PAs
- Suggestion made as to development of book of guidelines as had been done with VR
- Define roles of members—evidence of no representation from Counties
- Meetings—Meet more often and decrease length of the meetings, so that there is more memory—pull together some of the groups so as to deal with complex issues.
- Alternate other agency perspective meetings with broader systems change meeting
- Identification of content topic for each meeting
- Go back to once every other month meeting intervals
- Best practices determinations and dissemination. What is the content topic of the day?
- Work group work versus SIG group work
- Data stuff—send us in off-month and come back to meeting to explain—analysis or eyeball differences
- Look at different way for agenda to be handled. Generation of questions and give time to solve and obtain other input.
- Agenda group—Dan Peccia, Bill Lynch, Cindy Helvington, Dianne Duerscheidt, Kathryn Weit, Mary Lee
- Popcorn group—build the agenda—2 weeks prior send email to call for agenda items.
- Process (meeting enough, RFP group process)—
- Celebrating successes of the brokerages
- Brokerages
- Customer satisfaction surveys: standardization of forms and return rate needed for statistically valid data
No representative was available.
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- Customer/Family/Advocates
- Roadmap trainings—covered above
- Feedback on IEP interactions between transition teachers and PAs—covered above
- Family Stakeholder group is requesting another member. Person would be a family member of a customer receiving brokerage services. Marcie Ingledue and Bev Herrin responded that they may know individuals who may be interested.
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- Providers
Absenteeism data and policy
Reporting postponed until next meeting.
- Agency of Choice work group
The group has met twice with the task of reviewing the Agency of Choice (AOC) model with regard to increasing flexibility for families, helping with ameliorating liability issues and capacity issues for families. Lots of discussion occurred with realization of various issues associated with people’s resources.
Issues noted were that in general the model afforded customers limited purchase power. Services were not affordable for most customers, due to provider associated costs. COLA increase did not increase the purchase power. As far as the cap for the in-home rate being lower than out-of-home comprehensive rate, this was variable and dependent on a number of factors.
Discussion information that was felt to be helpful:
- Creation of a model pricing system for providing services with breakdown of what goes into the price (what goes into $23/hr). This would be shared with families and also serve to encourage marketing services.
- Question was raised as to what would be a reasonable rate +60%, and what would make it possible for providers to accomplish this.
- Recommendation was made that a template or book be created which could be shared with all providers.
- It was noted that in-home care-providing agencies charge $14/hr for activities of daily living. What are the other kinds of agencies, including state, which provide in-home services (not community inclusion or job coaching)? These agencies have the same fiscal intermediary, training of staff, insurance, recruitment, health benefits, as in-home service providers.
- With regard to cost difference, there is cost associated with control. Providers are working around the family versus family working around provider availability. Scheduling is a nightmare.
- It was felt that some learning process is needed to look at separation of administration fees from actual service fees, where plan funds could then be used for program services versus being spent on administration associated costs.
- What is reasonable for parents or providers?
- Having development of a bigger pool of providers with ability to spread the administrative amount.
- Employment discussion with regard to providing the incentive for having more money in a plan for a person engaged in supported employment, and a higher plan rate.
So as to determine what can actually be done, suggestion was made that this be the topic of a content meeting, whereby broader discussion could occur with other agencies presenting. Vision was expressed towards development of providers who may be flexible and create services, allow customers to be in charge and not have the responsibility. Workgroup will meet and define the problem, capturing some issues spoken of today, and report back to the SIG. As far as an individual at State who could speak on insurance/liability and workman’s comp, no contact was identified.
Strategic Discussions & Quality Assurance
- SERT data reports for Support Services
Reporting postponed until next meeting. A federal grant was received to implement a pilot with HSRI, in regards to a State customer satisfaction survey which would be conducted with brokerage customers in August. The survey is 14 questions long, with request for identification if done by proxy. This coincides with one brokerage’s annual customer satisfaction survey. The questions are not the same as those in the annual customer satisfaction survey, with focus on performance, trade and services, and Medicaid.
Retreat committee reports
Reporting postponed until next meeting as Erin Graff was not in attendance.
Review Meeting and Plan Next Meeting
- Next meeting is scheduled for Friday, September 28, 2007, at Resource Connections of Oregon in Salem from 9:30am – 3:00pm. The Customer/Family/Advocate group will meet from 8:30am – 9:30am.
- Remaining meeting for 2007 will be held on a quarterly basis—November 30, 2007.
- Agenda items for next meeting
- Conflict of Interest form
- Customer satisfaction surveys: standardization of forms and return rate needed for statistically valid data
- Absenteeism data and policy
- SERT data reports for Support Services
- Caseload Ratio Workgroup
Adjournment
The meeting was adjourned 2:05 PM.
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