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Official Minutes
March 16, 2006

Staley Implementation Group

Resource Connections of Oregon
Salem, Oregon 97305

In Attendance: Cynthia Owens, Bill Lynch, Dan Haynes, Kathryn Weit, Tim Kral, Arlene Jones, Pam Ring, Judy Cunio, Kristine Merritt (Judy’s PA), Charlene Dean, Marcie Alvarez, Caryl Knudsen, Pat Allen, Nona Scott, Joe Carroll, Bev Herrin, Mike Maley, Mary Ann Seaton, Margaret Theisen, Kim Sellmann, Jim Wrigley, Patricia Hildebrand, Robin Mouser, Marcie Ingledue, Sandy Stewart, Molly Holsapple.

Meeting was called to order by facilitator, Bill Lynch, at 9:35 AM.

Introductions and Announcements

Attendees introduced themselves and their stakeholder group affiliation. For the County Stakeholder group, Lynn Greenwood will be replaced by Dan Haynes. Sandy Stewart will be attending and Rod Branyan will be representing Mental Health Directors. Mary Ann Seaton will be representing Oregon Technical Assistance Corporation (OTAC).

March is Developmental Disabilities (DD) Awareness month, and on March 27, 2006, there will be a presentation at the Governor’s office in Salem. Members are encouraged to be at the State Capitol by 3:30 PM for the scheduled meeting with the Governor at 4:00 PM.

Review & Approval of Minutes

Corrections on November Notes:

Action: November 30, 2005, SIG meeting, those minutes will be sent electronically to members for review. Edits and corrections from the stakeholder groups are to be directed to Kathryn Weit within one week. Final minutes will be sent out electronically for approval in two weeks.

Issue: Format of meeting notes

Discussion:

Brief discussion was held as to whether the minutes should be more concise with a listing of bullet points and action items versus the current narrative form. Group consensus favored some narrative form, which tended to preserve the thought process by which the group came to decisions and recommendations.

Action: Request was made for volunteer note takers and development of note taking parameters.

Monitoring/Updates

Brokerages

Margaret Theisen reported that the brokerages are involved in several projects.

• Brokerage conducted Customer Questionnaires. Information obtained through these questionnaires is projected to be reported at the July SIG meeting.
• Attention to the fiscal intermediary (FI) portion of the brokerage system—cost of operating FI system; issue of being employers, co-employers; what is agency of choice; etc. Suggestion was made that there be an in-depth FI overview presentation at a future SIG meeting, so that stakeholders can gain better understanding of the issues. Brokerages felt that they themselves needed to develop a better understanding first, before being able to present to the SIG.

Action: The FI overview presentation can be set as a future agenda, with the caveat of checking in with the brokerages at each meeting to find out when the presentation can be done.

• Caseload issue workgroup. Larry Deal from Developmental Systems, Inc. (DSI) is representing brokerages in the workgroup, which is examining caseloads—what does it look like, effects on the personal agent (PA) and budgets, etc.

County

• New representative, Dan Haynes, from Multnomah County, introduced himself to the group.

Issue: Confusion over services to individuals in high school transition age group

Discussion: At the recent DD Program Managers’ meeting, the issue around expenditure on employment related support in regards to individuals in the high school transition age group was raised. If an individual is high school transition and not getting services from school, can support service funds be used? There are 3 or 4 DD program managers working on this and they are in contact with the Oregon Department of Education (ODE).

Action: Clarification on the support services policy will be obtained at the next DD Program Managers’ meeting.

Customer/Family/Advocates

• The Customer/Family/Advocate group met and discussed the issue of conflict of interest as related to the role of the family.

Issue: Conflict of Interest

Discussion: Conflict of interest being defined as “existing when someone other than the individual with disabilities is involved in the decision making and has a financial interest in or the potential to benefit from a particular decision, outcome or expenditure.” The group reviewed Wisconsin’s Conflict of Interest Statement. The group is making the recommendation that there be a uniform conflict of interest statement used in Oregon to address any issues that might be raised by CMS. The group is requesting opportunity to do some research with Stakeholders: Do brokerages and counties have any written conflict of interest policy and forms? Do brokerages and counties have procedures in place for these policies? What are the perceptions are to how the policies and procedures are working?

Action: Brokerages and counties will be asked for copies of their written conflict of interest policies and forms to be sent to the Customer/Family/Advocates group through Kathryn by the 3 rd week of April. Mike Maley offered to review what other states may have in place.

Providers

• State systems transformation grant to focus on individual assessments, how things are paid for, etc, is moving towards consumer choice (Support Intensive model) with application across all waivers. Bill Uhlman from Eastern Oregon Support Services Brokerage (EOSSB) is on the group.
• Individual Support Plan (ISP) revision group is working on the comprehensive system ISP revision.

SPD Update

• SPD is doing some reorganization. Mary Lee Fay and Mike Maley will now be focusing on DD exclusively. Other parts of the office like licensing will remain the same.
• Annual Report (sent in advance)

Staley Process Report #4: Staley is on target with benchmarks of the modified agreement. The report is sent to the plaintiffs as part of the Staley agreement.

Discussion: Question was raised as to whether our waiver is going over $20,000. Response was that customers over $20,000 were those individuals who were being grandfathered in through other programs. Overall there has been an increase in total enrollment. Age trend shows younger age individuals entering into the system. Discussion occurred as to the ethnic demographics and providing outreach to ethnic and other diverse populations. Some outreach is occurring, although cultural differences are barriers.

Action: Suggestion was made to include a column in the tables containing the previous year’s data for comparison in addition to its present form in the narrative.

• Issue: Brokerage Backfill

Discussion occurred over the issue of backfilling for individuals moving into comprehensive services. Not allowing brokerages to backfill individuals when there is a termination has been a cost saving feature, but this may result in a budget issue for 2009-2011. It is felt that a portion needs to be backfilled by individuals waiting for services for 2007-2009 to ease a future budget strain. This would involve a change in the rate of enrollment. There has been a 20-30% increase in the number of individuals entering into the DD system over the past couple years with 2/3 rds being children.

Action: The SIG made a recommendation to Seniors and People with Disabilities (SPD) to allow brokerages the ability to backfill at least 50% of those customers who leave the brokerage into comprehensive services.. The recommendation was approved by consensus of the SIG with abstention by Mike. This recommendation will be crafted into a letter by Jim Wrigley through and sent to James Toews.

• Data report

Issue: Enrollment/trends, etc.

Discussion: Document developed to review the concern expressed that the FS/High School Transition age group dominated the enrollment in some areas. Information gathered is being focused on four counties (Coos, Curry, Multnomah, and Yamhill). Consideration is being made of making adjustments within regions.

• Comp 300

Issue: Rules

Discussion: Waitlist rule modification for Comp 300 is currently in process and has to go through formal channels before being brought to the SIG.

Action: Mike will forward the formal rule hearing announcements to Bill and Kathryn, who will then disseminate the information from the Council office.

• Supported Independent Living Program (SILP) transfer

Discussion: Molly Holsapple spoke on the SILP transfer of 229 individuals into the brokerages. This is not a simple transfer of existing services, as each individual can have very complicated and involved support issues. Medicaid or waiver eligibility has been established on less than 30% of these individuals. Individuals will be looked at one at a time and a roll-out instituted from October 1, 2006, through May 30, 2007. Passage to Independence Project (PIP) Benefits Planner—about 10-15% of the individuals in SILP would be referred to a team of PIP benefits planners at the Oregon Advocacy Center (OAC) to assist individuals who are working or want to work to access and use Medicaid and Social Security Work incentives. Of 80 individuals currently working, only 15 are on Employed Person with Disability (EPD). In most instances the SILP individuals will be receiving fewer funds than currently afforded.

• SILP Advisory group—the SIG was asked for individuals who would like to be a part of this advisory group.

Discussion: The Advisory group would meet monthly in Salem, starting the 3 rd week of April, 2006, and continuing through June, 2007.

Action: The following individuals signed on—Sandy Stewart or another person from Marion County, Patricia Hildebrand, Caryl Knudsen, SAAL will identify a self-advocate (including a person who is in SILP).

Top Strategic Priorities

Issue: New Brokerage—update and data—

Discussion: In consideration of numbers of individuals turning 18 by end of next biennium and other assumptions, brokerages are being asked two questions:

(1) If numbers are such that a brokerage could expand to take care of the need (southern and eastern regions), would brokerages be willing to increase their capacity?

(2) In needing a new brokerage in the Metro area and SE regions, would brokerages be able to make recommendation for changing catchment areas to expand their capacity?

Other ideas included having an established brokerage serve as a host or mentor and a new brokerage developing under the mentor. At some point in time the new brokerage would break off as a separate entity. Oregon Department of Administrative Services (DAS) rules are changing so it may be necessary to do a request for proposal (RFP) if there is known competition. Another idea was satellite office development which would fit with ESSOB or SORB. Timelines are unknown, but there is need for consideration of the budget. Need to nail down target number for next biennium.

Action: The SIG should be involved in a discussion as to the size of brokerages, as this was an initial concern, resulting in the establishment of 350 as a minimum and 700 as a maximum.

Issue: Rate Workgroup

Discussion: Tim Kral reported that the group had met and it was determined that the rates providers charged brokerage customers was not an issue—if brokerages can buy what they want then it is not a rate issue. Providers may have problems with the rates, but brokerages have been able to buy enough services for their customers. Some supports can be very hard to find, especially if there is dual diagnosis, drug and alcohol issues, high behavior issues, need for an hour in the morning and in the evening personal care. The group hopes to gather more information on the capacity issue over the next few months.

Issue: Caseload Ratio

Group including Larry Deal, Pam Allen, Caryl Knudsen, Amy Perry, Cynthia Owens, Kathy and Kristie Holmquist, Peggy Lovelace, Tom Giles, Mike Maley have met once.

Discussion: SPD perspective on this issue is one where brokerages should not expect an influx of funds to change the caseload ratio, i.e. – no compensation to change caseloads. Continuation of efforts on the work simplification piece, incorporating what had been done previously; answering questions of is it necessary or can it be done differently; reviewing practice policy and examining all those things that brokerages and PA’s have to do that take time away from the face to face contact with customers. Consideration is also being made of fundamental assumptions on a bigger scale, such as having the county educate/orient individuals coming into the brokerage (versus this being a brokerage/PA function).

The SIG workgroup from the Strategic Planning Retreat will continue to work on this and there will be continued discussion within the brokerages, especially in regards to consideration of the establishment of new brokerage(s). Next steps for the group include the following:

• Some of these issues, such as the simplification of work, are being addressed as agenda items in brokerage meetings.
• In refining paperwork, a time study conducted last year by the brokerages showed that 50% of PA time was spent on paperwork and 25% of PA time as direct customer contact. In response to the time study, a large concerted effort had followed to streamline and consolidate paperwork, but it was concluded that required paperwork could not be reduced significantly. Currently efforts are being done with providers to refine some practices which may result in some paperwork reduction. FI activities generate a great deal of paperwork.
• Examination of what OARS can be changed which will result in simplification of the work process. It is not known what group will look into this.
• Brokerage director group will look at policy.

Action: Bev Herrin or Margaret will contact Larry, so that Larry can get information and other materials to Caryl. Caryl will convene the group. The Caseload Ratio workgroup will then do a presentation at the next SIG meeting.

Quality Assurance

Issue: Support Services Expenditure Guidelines

Discussion: The Support Services Expenditure Guidelines were reviewed by the SIG.

Action: Make the following changes

• #1—“DIRECTLEY…” should read “DIRECTLY…”
• #2—“productivity” instead of “employment” (taken from what the law says); recommendation was made to add employment to this line, so that it reads, “…relate to independence, employment, community participation and/or productivity.”
• #7—relates to items such as equipment

Issue: Review in-home supports consumer satisfaction survey (CMS)

Discussion: This would be the survey that the state would require as it would be part of their QA efforts across all agencies. The survey’s field test went well. It was found that results received by mail were just as good as those received in face to face interviews (i.e. – similar results).

Action: If anyone has questions or concerns, please direct them to Arlene Jones or Bill.One individual expressed that the wording of question 10 was redundant.

Retreat Committees Reports

Issue: Training Committee (Training for Families and Self-Advocates Workgroup)

Discussion: Cynthia and Arlene presented on the work that had been done by the Training workgroup consisting of both a “Framework” subgroup and a “Targeted” subgroup.

Framework addressed that period of time where an individual was entering the brokerage and had compiled and developed a table listing materials which would be used in training activities alongside the manual, “A Roadmap to Support Services.”

Targeted focused their work around employer/employee issues and natural supports. The presentation focused primarily on the efforts of the Framework group as related to those outcomes and recommendations that had come out of the SIG Strategic Planning Retreat. The training activities included a “train the trainer” model involving individuals (customers and families) in local communities, having the materials housed in the brokerages, or on a dedicated website. Funding would be necessary to implement trainings.

Brokerages were willing to provide some stipends to trainers, though it was stated that Brokerages could not be expected to provide full funding for this project.

Action: Recommendation was made that there be development of a script and a presentation at the Direct Supports Conference (July 19-21, 2006).Arlene will send the materials presented to Margaret and Bev electronically. Cynthia and Arlene will go back to the group for a discussion of a possible half-day presentation at the Direct Supports Conference. The group was thanked for all their work.

Conflict of Interest

Discussion occurred during the Updates from Customer/Family/Advocates.

Next meeting scheduled:

The next meeting is scheduled for Wednesday, May 24, 2006, location to be determined. Arlene was thanked for taking notes.

Agenda Items:

SPD Budget package

In-depth FI Overview (check in with brokerages at each meeting to find out when this presentation can be done)

Caseload Ratio Workgroup presentation

Adjournment:

The meeting was adjourned at 2:55 PM.

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