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Official Minutes
March 23, 2007
Staley Implementation Group
Resource Connections of Oregon
Salem, Oregon 97305
- Next meeting is scheduled for Friday, June 22, 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 meetings for 2007 will be held on a quarterly basis—September 28, 2007 and November 30, 2007.
In Attendance: Cynthia Owens, Cindy Helvington, Judy Cunio, Carol Simonds, Arlene Jones, Marcie Ingledue, Margaret Theisen, Nona Scott, Erin Graff, Dan Peccia, Mike Maley, Tom Racioppo, Mike Parr, Pam Ring, Kathy Holmquist, Jim Wrigley, Pat Allen-Sleeman, Joe Carroll, Tim Kral, Dianne Duerscheidt, Mary Lee Faye, Dawn Andersson, JoAnne Fuhrman, Bev Herrin, Robin Mouser, Patricia Hildebrand, Bill Lynch.
Meeting was called to order by facilitator, Bill Lynch, at 9:35am.
Introductions and Announcements
Introductions were made.
Review & Approval of Minutes
It was moved and seconded that the October 5, 2006 minutes be approved. Minutes were approved by consensus.
Monitoring/Updates
SPD Update
With regard to staffing, Gerry Stolp has retired and is providing orientation to his successor. Two regional coordinators have been hired—Claudia Zamora has been assigned to Multnomah and Clackamas counties and Maria Forrest has been assigned to Tillamook and Yamhill counties.
- Information on Title XIX Waiver form
In order to be on a home and community based waiver, the individual has to be eligible for Medicaid; meet the criteria for developmental disability; and require a level of care indicating that in the absence of community based services, would be eligible for an Intermediate Care Facility for People with Mental Retardation (ICF/MR). Copies of the Title XIX Waiver Form were distributed. The functions of the form are: (1) eligibility determination and (2) offering the choice of community program or placement in ICF/MR. Question 12 pertaining to the choice offered, can not be removed from the form.
CMS comments on the form were that it was hard to follow and that it became difficult to read as the original was written over in updating information. The newer revision draft is more condensed, with greater clarity on customer choice and directions for filling out the form (process for updating on an annual basis and whether to be in the presence of the individual). The new form does not list diagnosis, aligning more with level on function.
- Data report: Enrollment/trends, etc.
Information on the 18-21 yrs data was tabled until the next SIG meeting. Eva Kutas would be speaking on protective services data later today.
Total number of individuals in support services is nearing the 5000 mark. It is estimated that there are 6000 individuals in service coordination only (the majority being children), 5000 in comprehensive and 4940 in support services. Under reasons for enrollment, numbers are starting to reflect the Semi-Independent Living Program (SILP) enrollments. Percentages seen in comprehensive services include those moving into the Comp 300 services and those entering through crisis services.
Question was raised as to what happens to the Comp 300 slots that are terminated and the funds associated with those terminations. Budgeting included the assumption of 12 individuals per month leaving. As the data supports the budget assumption, no backfilling has occurred. The funds enter into the general pool for comprehensive services. This policy will be dropped with the next biennium because of the goal to reach the zero level.
With regard to breakout by brokerage, data shows numbers reaching brokerage capacity, with most brokerages in the mid-80% range. SDRI is at full capacity and maintaining that level. Overall, brokerages are averaging 46% of customers entering from groups 4-5 (Children turning 18 with CIIS or Family Support, and Individuals Aging out of School), and 54% coming from the General Waitlist.
The demographics of people entering into the brokerages are similar to previous years. Terminations averaging at 12 customers/month, with a few more individuals in the deceased (but not protective services associated) category and the moving away from area category. A shift was observed in plan dollars with 52% of plans below $9600 (previously 66%) and the rest above $9600—highest shift occurring in the number of customers in full base plus.
The Staley Annual Report will be posted on the Oregon Department of Human Services (DHS) website with a link between the Seniors and People with Disabilities (SPD) webpage and The Arc of Oregon website.
The Governor’s recommended budget for Staley remains strong, and includes the next biennium roll-up and anticipated rise in plan dollars. The Comp 300 budget is to assume more of a group home or supported living style of development. The budget presentations by the Co-Chairpersons of the Joint Ways and Means Committee were difficult to understand, differing from the Governor’s budget, because of having more revenue to work with. Their budget incorporates forecasts in December, and also what they are seeing and hearing on legislative priorities. For developmental disabilities, the provider rates is visible and an important issue. No clarification has been received on the exact amount. Healthy Kids is not referenced because of its association with an increase in cigarette tax.
The first Centers for Medicare and Medicaid Services (CMS) visit on support services and comprehensive waivers in Oregon, occurred in January 2007. The visit was to provide verification that individuals who were eligible were getting their needs met; that individuals received informed choice and understood their rights; and to bring awareness of quality assurance to the State.
Verbal response post-visit was positive. CMS noted that a lot of partner work was occurring on policy issues. The manual, “A Roadmap to Support Services,” was seen as a national best practice. On a strategic level, CMS noted that a lot of pieces of information were being obtained by the State and CMS would like to see that the State uses the information effectively. CMS would like to see more State involvement in the appeals process. They realize that management is at the local and county level, with most issues being resolved at that local level, but CMS would like to have the State play a more active role in knowing what the issues are for quality assurance. Ensuring that individuals have access to rights was also noted.
The final report from CMS is expected to be issued in July 2007.
Request for Proposal (RFP) has gone out for two new brokerages, with April 10, 2007, as the close for proposal submissions. Next steps are the formulation of the review panel and actual review of submissions. Determination of the review panel will be dependent on the RFP respondents.
Concern was raised and conversation followed as all members of the SIG had not received notice of the RFP being opened. Request was made that updates as to the results of the RFP be sent to the SIG.
- Brokerage Field Review Report—Tom Racioppo
Since 2004, SPD has been visiting brokerages to conduct evaluations. It was noted that this is the first time comparative data is available. Things are looking great.
With regard to Individual Support Plans (ISP’s), it was noted that each year has seen positive increases, with benchmarks being exceeded. Under Administrative, the Quality Assurance components of customer satisfaction and Personal Agent (PA) training showed decreases. The drop in Customer Satisfaction may be attributable to the change in survey type. With regard to PA training, the value was affected by various factors such as the absence of trainings and non-submission of any staff qualifications by one brokerage. An issue noted was the lack of documentation.
Next steps include trainings on goals, protective services, and PA best practice group. Mike Parr has been working on a website to support PA’s with information and resources.
Discussion occurred with regard to the consistency and confidence levels of data collection of the Customer Satisfaction Survey. Brokerages were asked to review the questions of the customer satisfaction survey for standardization and obtain verification of the statistically valid threshold percentage of returned surveys, which would then be used by all brokerages.
- COLA implementation for Brokerage customer plans
All providers (with the exception of general businesses) get a commensurate increase in cost of living adjustment (COLA) as well as customers. Caution was noted that COLA not be used differently from the legislative intent. Issues are around how to automatically include cost of living increases. At some point individual customer overall budgets will need to be examined. Brokerages would be getting an increase on administrative dollars. Some providers have already incorporated increases and the COLA may be an overlay. Another consideration is capacity building.
Discussion followed. Implementation issues include: (1) how to do this equitably for all customers, without customer plans being changed; (2) increases would not necessarily occur in all parts of a customer’s plan; (3) benefit levels; (4) provider rates and wages; (5) employer/employee relationship; (6) administrative issues; and (7) replication in the future. Consensus was towards as simple a method as possible, with guidance letter issued from SPD to the brokerages.
Next steps—Brokerage directors and SPD to meet to work on details. Actual funding numbers are expected July 1, 2007. An update is expected at the next brokerage meeting, scheduled for June 22, 2007.
Report on Comp 300 placements as of March 22, 2007, was distributed. Of those entering into comprehensive services, 65% were in supported living, 23% in foster care, and12% in group homes. Majority of enrollees were in the family home or living on their own. 68 people left brokerages so the plan is to enroll people as a backfill. This is problematic in three of the brokerages. Some Counties did not develop Comp 300 opportunities. Question raised about what happens if a person leaves comprehensive services and the response was that the capacity remains available with another individual being able to enter into comprehensive service. These are not 300 on-going crisis “slots”. They become part of the overall base when there is turnover in the Comp 300 opportunities. Plan for next year is to start with a July work group, similar to what occurred this past year.
- Protective Services Data and Information (Comp vs. Support Services)
Eva Kutas and Joe Mayfield, Office of Investigations and Training. The primary difference in the statute between Comprehensive and Support Services are that financial, verbal and a broader definition of neglect are the areas in Comprehensive that do not exist on the Support Services side. Brokerages are required to respond to abuse, via reporting to the Counties who manage the formal Protective Services Investigations (PSI). Joe provided a 2-year summary of the data “2005 and 2006 Brokerage Abuse and Neglect Investigations”. Question was raised by the SIG (and it has also been raised by CMS) about what is done with data. The legislature has outcome measures about repeat abuse. Trends are looked at. Trend data will point towards the need for other service providers (ie.—victim services, domestic violence services) to become educated about these issues. These issues are addressed on a case by case basis at the local level. At times, some of the responses are to sanction providers involved with PSI actions. Reports from Counties do have recommended actions when a PSI occurs. Court system support, such as restraining orders can be accessed. Conflict of interest issues in this area need to be addressed and are being worked on. The in-home settings are complex and policy discussions need to address the concerns.
- Semi-Independent Living Program (SILP)
Effort is pretty much winding down. There are 2-3 counties which may not make the April deadline.
- Proposed pilot project regarding County DD Programs and plan authorization
The authorization process has not necessarily affected customer plan changes, but has served in other ways. In a few locations, there will be a pilot project to have the authorization by Counties ceased. A waiver change will be required to enact this. Another resolution to pursue is to understand how to move the funds based upon contact hours that previously generated dollars to be allocated to Counties. Although there are several options, nothing specifically has been agreed upon. Intentions are to maintain the communication and connections between brokerages and counties. This could be implemented in fall 2007.
- Conflict of Interest form
The State is in possession of the form, but further work has not occurred. Answers to additional policy questions (ie.—when a parent is not doing a good job, what do we do?) have yet to be resolved. The concept of a Conflict of Interest Form has a place but it is a much bigger issue. The DD council is taking on this issue too. Cynthia Owens and Mike Maley will meet for further progression.
- Brokerages
- Fiscal Intermediary Issues
Report provided “Customer & Family Risks Fiscal Intermediary (FI) Services in Support Services for Adults.” Risks to customers and families include lack of workers compensation, the complications of employment law, and Bureau of Labor and Industries (BOLI) issues. Brokerages believe they have the responsibility to provide education regarding these issues, which tend to be identified at the level of PA interactions with customers. Better training for PA’s on this needs to occur. Although some materials have been developed, there is a paucity of material.
Agency With Choice (AWC) is another approach to take that could address some of these issues. AWC is currently not available in every part of the State and the cost is high. Example given stated a $9 hourly cost for this service. Question was raised as to whether there is a body of law regarding this. None specifically could be identified at this point. It was noted that some of the domestic employees have relationships with customers, which may stop them from filing lawsuits. One possible approach on training is a Roadmap for employment and FI issues. The training could help to provide structure for developing the AWC model as one possible choice.
Outcome—brokerages will have a brokerage level workgroup on the customer training. Interest was expressed in formation of an AWC (provider with choice terminology was also used) workgroup. Dan Peccia agreed to convene a meeting for this workgroup. Question was raised about start up funds for providers to do model development. Response received was that some broader conversations regarding all capacity development is happening. The notion of a White Paper was raised.
AWC Workgroup to consist of: Judy Cunio, Bill Lynch, Cynthia Owens, OTAC representative, Bev Herrin, JoAnne Fuhrman, Marcie Ingledue, Pam Ring, Dan Peccia, and Kathryn Weit.
- Longitudinal Customer Interviews
The brokerage Customer Interviews draft plan was shared. Question was raised with regard to capturing Oregon Vocational Rehabilitation Services data.
- Rotation of brokerage representation
Vee Ann Ambers from Southern Oregon Regional Brokerage (SORB) will be representing brokerages and Margaret Theisen is rotating off.
No representative was available. Bill will contact Sandy Stewart about County representation.
- Customer/Family/Advocates
High school transition issue update
Currently there are school districts decreasing high school transition hours to half days or a few hours per week. Oregon Advocacy Center (OAC) is gathering information on this. This trend seems to be occurring statewide. Any incidents with regard to this should be reported to Cynthia or Marcie Ingledue. This is seen as an urgent issue. Cynthia will ask Susana Ramirez from OAC to present at the next SIG meeting.
Issue of on-going loss of dollars for providers in support services delivery. One report indicated a 20% loss in providing support services. Rates that allow a break-even budget are too expensive for families. Staff needs to be guaranteed an income and gaps in billable time have a huge impact. This is occurring at many agencies. There are some variations in different areas of the state, ie—Metro area. Discussion occurred regarding the absenteeism policy and that it was noted that the policy is not utilized a lot. How this relates to the REBAR have been that REBAR is not support services or foster care, etc. The Waiver rewrite is a couple years away. Tim Kral recommended re-examination of the absenteeism policy. Recommendation was also made to add Independent Contractors to the absenteeism policy. Further clarification is needed on identification of the issue. Tim will gather more data and report back.
Strategic discussions
Retreat committee reports
Copies of three power point presentations developed and used by members of the Roadmap training group were distributed, covering self-determination, person-center planning, and what is a brokerage. Question was raised with regard to training funding and with subsequent follow-up being requested. Discussion occurred as to development of a website for sharing of the materials. Recommendation was made that the present materials be posted on either The Arc of Oregon or DD Council websites. Materials for PA trainings which the brokerages are looking into, could also be posted.
Review Meeting and Plan Next Meeting
- Next meeting is scheduled for Friday, June 22, 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 meetings for 2007 will be held on a quarterly basis—September 28, 2007 and November 30, 2007.
- Agenda items for next meeting
- Retreat Workgroups—Caseload Ratio Group. It was noted that there has been a lot of turnover in the group. Plan is for the group to meet prior to the next SIG meeting.
- OAC presentation on high school transition issue.
Adjournment
The meeting was adjourned 2:35 PM.
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