Staley Implementation Group Meeting                 Previous Meeting Next Meeting
Official Minutes
November 30, 2005

Staley Implementation Group

In Attendance:  Bill Lynch, Kristin Muller, Judy Cunio, Pam Ring, Jim Wrigley, Nancy Hazelett, Nona Scott, Cynthia Owens, Arlene Jones, Patricia Hildebrand, Robin Mouser, Marcie Alvarez, Kathryn Weit, Caryl Knudsen, Pat Allen, Joanne Fuhrman, Cindy Helvington, Mike Maley, Marcie Ingledue, Judy Cunio, Kristine Merritt, Margaret Theisen, Martha Stracener, Scott Pelham, Mary Lee Fay, Bev Herrin, Dan Peccia, Kathy Holmquist, Tim Kral

  Meeting was called to order by facilitator, Bill Lynch at 9:42am.

ANNOUNCEMENTS

No announcements were made.

  MINUTES

Minutes were reviewed and approved with the following changes:

• The letter from the brokerage directors did not include information on fiscal impact.
• The spelling for Margaret and Martha’s last names was corrected
• Page 5 should be “between the employer and the fiscal intermediary”

A recommendation was made to have the minutes sent out a week or two after the meeting. This will allow people more time to follow up on action items.  The recommendation was noted and an effort will be made to get minutes to members quickly after the meetings.

Action: We will try to get minutes to members within two weeks.

MONITORING/UPDATES

Brokerages

Concerns –

• Comp 300 is being discussed at the county level. Is there a role for brokerages?  The brokerages are hoping the county will include brokerages in the process and discussions. 
• Medicare is now doing a prescription drug plan with approximately 20 different providers and 43 different plans; you can sign up for one of the plans now, however, it is very complicated.  The Medicare website (www.medicare.gov) is not entirely accurate, which could lead to an increase on workload, as brokerage customers may need additional assistance with signing up for the plan that best suites their needs. 
• FAB, EOSSB, and Inclusion have all completed, or are in the process of completing, their annual reports.  Eastern Oregon Support Services Brokerage has theirs posted on their website (www.eossb.org) and FAB has theirs at www.fullaccess.org. 
• MMIS (Medicaid Management Information System) is a federal payment system required of the Department. The state is being required by the Centers for Medicare and Medicaid Services (CMS) to update our current MMIS.  CPMS is a related State payment system that is very outdated and will not meeting future needs.  .  As we develop a new MMIS, CPMS will need to be replaced as well.  MaryLee noted eXPRS was created as an immediate partial replacement for CPMS and is now processing about 75% of the bills. The down side is that eXPRS may have some overlap with the new MMIS or could eventually be replaced by it.  The state will then compare the two (eXPRS and  MMIS) through December 2005 to determine how these two payment systems will relate in the future.  If you want to see an example of a billing system, you can go to the state of Kansas website.  It was noted that Colorado is struggling with the same issue and is now looking to Oregon and waiting to see what comes out of the experience with eXPRS.
• Margaret mentioned capacity building development issues…. a plan is to schedule (within the next few months) a group of customers to have in-depth discussions that will help define some of the capacity development issues.  Margaret asked:

Should we do this? What will we do? What will the information be used for?

What would you expect the usage of this to be?

If the data is gathered and we see where there are big holes, we may not be able to fix all the holes but at least we will know where the holes are and what to be working on.   

Bill added it is important to compare the new survey to the customer satisfaction survey already in effect—maybe combine some of the questions, as you don’t want to overload customers, families or brokerage staff with redundancy.

Action: For the customer questionnaire handout – make your adjustments and the changes that you feel would increase the usefulness of the survey and get it back to Margaret Theisen.  Margaret will compile any comments given and will fine tune the survey.

County

No county representatives were present to give the report.

Customer/Family/Advocates

The Customer/Family/Advocate group did not meet this morning, in lieu of the Role of the Family Workgroup’s meeting.  A protocol for electing members was developed by the Family stakeholder group, whereby current members would identify individuals through their community networks as well as by approaching the brokerages to identify family members as potential candidates.  Candidates would be contacted and reviewed.  Approval would be obtained by consensus of the family stakeholder group, with presentation of the new member to the SIG. 

The Customer/Self-Advocate representatives are addressing their process for electing new members. 

Revision has been made to the original “Roadmap to Support Services” manual, and the revised version will be sent to the State for a second printing.  All copies of the original version have been distributed to brokerages, counties, etc, and there is need for more copies at this time.  The second edition will be translated into Spanish.  Cynthia Owens has sent the manual electronically as a PDF. 

Providers

The process for replacing members on SIG was discussed.  It was noted that originally members were elected by a meeting of providers.  To replace provider representatives, they will recommend new members to the ORA board and the board will decide. 

Concern was expressed that providers who are not members of ORA should also have an opportunity to participate.

The agency provider stakeholder group meets prior to the SIG meetings.  There was discussion about combining the meeting for domestic employees, independent contractors and representatives from provider agencies.  The provider group will decide how to select new members, as well as whether or not they (DE’s, IC’s, and reps from agencies) will participate in the provider meetings.

Independent Providers

Currently Independent Providers don’t meet or communicate outside the meetings. It is important that we hear the issues of independent providers from around the state.  The question was raised whether there is some way a designated person could disseminate information to Independent Providers? 

Action: Someone from the Independent Providers group needs to step forward to take on this challenge.   

(There was a green roster form passed around at the SIG meeting with contact information of all members.  This list had members only.  The web posting will include name and email contact information only.

Action: Bill wants the process for selecting members from all groups written up in a handout by the next meeting to formalize it.  Also, discussion about a mission statement will be added to the next agenda.  Kathryn will bring in the information that was used when the group formed originally.

SPD Update

People leaving brokerage services:

•  
• Handout shows why people are leaving brokerages.  The budget assumption was 12 customers would exit brokerage services in the state each month.  Instead of looking at the absolute number of exits, one future additional analysis might be the percentage of terminations compared to the increasing number of enrollments. Clarification that the handout refers to customers moving out of area.  They left the brokerage system altogether—this is different than transferring to a different county or another brokerage.

RFC  - Relative Foster Care – Definition - there was an old program under developmental disability services where under very specific circumstances a relative could become a person’s foster care provider is approved by the state.In addition to the number of exits, the state is currently trying to find out each person’s story as to why they exited brokerage services into comprehensive services.  The number of people exiting out of brokerage services into comprehensive services is relatively small, but a high percentage of the total of those leaving brokerage services. 

Crisis:

It was noted that the crisis system is having major issues.  The State is looking into why the numbers of people going into crisis is so much higher than projected.

Brokerages note that there is a bigger percentage of people coming in that have more complex problems and needs.  If people are coming in with higher level of PA support needs, it does require more work on the part of PAs.

Cash flow Issues:

3 brokerages have used a process to address the cash flow issues for the service funding (funds used to pay for customer services). So far it seems to be working. Margaret noted that FAB is facing about a ½ million dollar shortfall for this fiscal year.  Mike said he believes all brokerages will eventually face cash flow problems at some point.  The PC 20  created an additional cost of service funding on the brokerages. The State is working on this issue.

Differences in Plan Costs:

Changes in plans, changes in providers and finding someone to provide what the customer wants are the main reasons for the difference between what is estimated to be spent and what is actually spent.

Comprehensive 300:

• The goal is to get 300 people into comprehensive services by the end of the Staley Settlement Agreement.  This includes 24 hour residential (group homes), supported living, foster careand In-Home Services over $20,000.00 a year.  To be eligible individuals could have support services, no services or SILP.  Currently there are 256 people in enrolled in the SILP program; 3,700 people are receiving support services, and with current estimates of approximately 1,500 adults in Oregon have no services at this time.  SILP is included in this group because they are not in comprehensive service. Regions will look at who to serve in their areas.
• Kathryn mentioned the intent of Comp 300 was to address the waitlist of people living at home. This small number of comprehensive service “slots” was the compromise in the original Staley Settlement. It was not intended to be only available to people needing minimal supports or to try to solve other problems within the system.  This issue will be addressed in a future meeting.
• Mary Lee noted that 130 people will be enrolled in comprehensive services through the Staley Settlement Agreement for non crisis comprehensive services in this and the next biennium.

Lunch was served shortly after noon.  The meeting resumed at 12:20pm.

Comp 300 (cont…):

• Dan Peccia reported that brokerages were asked for a list of names for who they feel should be part of the Comp 300 consideration in their area.

FAMILY  AND SELF ADVOCATE TRAINING

Cynthia Owens reported:

• The Framework group has gathered materials to be used consistently to educate customers and family members about roles and responsibilities. This will help them understand their role in brokerage supports.  The Roadmap is a basis for the training.
• Joanne Fuhrman and Jane Glancy recently joined the group and will look at the employment-related materials and offer their expertise.
• Trainings are on hold until dollars can be found.  Training materials are still in the process of being gathered and fine-tuned (person-centered planning, self-determination, history and philosophy, etc.)
• Bill asked if the Roadmap would be used for only existing customers or if it will also be used to educate potential brokerage customers through high school transition programs.  Cynthia answered that the Roadmap will be used to educate existing customers, as well as new folks enrolling into the brokerages, such as through high school transition programs.
• Cynthia noted the group is also identifying how to overcome barriers to limited participation. The group is looking for any ideas about how to get more people to participate in the training.

·        Idea/Reasons for training: customers and families will get a better understanding of the brokerage support services. We want to get them the general information they will need to succeed in the brokerage system. 

• The Targeted group is looking at employment issues.  Idea/Reason for this is to give families tools currently used by brokerages. This will eventually take some of the load off of the Personal Agents and other brokerage staff when families and customers are trained and truly understand their role. Joanne asked if curriculum will be reviewed by the entire SIG group.  Cynthia replied the materials can be made readily available to the entire group, if the group would like to see them.

·        The Problem the group faces is there are no training dollars to get these trainings out into the community.  Even by partnering with other organizations, there is not enough money to pay for getting the training out to all areas (regions) in the state.

BOLI/IRS lessons learned:

Tim and Bev have no report at this time.

Kathryn explained that this request stemmed from the group wanting to know what was successful from the training they attended.  Bev and Tim will report at a future meeting

ROLE OF THE FAMILY POLICY DISCUSSION

A presentation will be made to the entire SIG group and from that presentation, recommendations will be made regarding conflict of interest issues.

The role of the family is a broad topic.  There was a telephone conversation around hot topics for discussion. 

Focus today: (Robin Cooper raised the issue) when someone lives at home with their parents and the parent is the legal guardian, employee, or both, what is the procedure for identifying and protecting customers from conflict of interest issues? 

• If the individual is both the employer and employee, a third party signature is necessary to verify that services were in fact delivered.
• Martha noted that even if someone has a legal guardian, the customer could still be the employer—the customer could still sign off on the timecards, and the guardian can be the employee.  Mary Lee said it would be a good idea to identify what type of guardianship it is. If the individual has a guardian, can they really be an employer? With some kinds of guardianships it might be possible for the customer to have a legal guardian but still be the employer. In other situations, maybe the customer really needs their guardian to sign off on the timecards, etc.

Recommendation: Judy made a recommendation that if the legal employer is also the employee, there needs to be a third party to sign and verify that services were delivered.

• Mary Lee: when do you apply additional safe guards?  And what are those safe guards? Pam Ring asked how a third party would be able to verify the work being done if that person didn’t witness the services being delivered. Kathryn stated additional discussion will follow in a small (adhoc) committee.
• When families push for one thing and the customer pushes for another thing, how do you resolve, or even identify, the conflict of interest…how does this get resolved?  What is the mediation process for this type of conflict between customers and members of their families?  (Family dynamics can be challenging.  Bottom line: Medicaid dollars follow the customer, not the family.)

Action: Role of family and self-directed supports will remain on the agenda for next meeting.

Top strategic priorities to track at every meeting

• SILP transfer:

Ongoing implementation—Mike Maley gave a brief update…SILP transfer is in process (Molly Holsapple is gathering information);

• Biennial certification reviews of brokerages are underway by the SPD licensing unit;
• Waitlist w/o services issue is being addressed and folks were identified through the county and enrolled into case management services (CPMS) for next biennium.

Action:  Mike will provide the waitlist data at the January meeting.

• eXPRS vs. MMIS—still unclear which  payment system will be used for what in the future;

state is implementing an overall rate restructuring project as part of a CMS infrastructure grant.

• Expenditure documents:

Quick reference sheet with what you can and can’t purchase through support services brokerage plan dollars.  This is included in the packet.

Requirements are listed in detail and an explanation given. Documents were reviewed.  This helps clarify what is an allowable expense under Medicaid—identifies restrictions, etc.  Mike noted that this helps the State make decisions around what is allowable and what isn’t.

Also in the packet are some of the more difficult issues that are debated as allowable under federal Medicaid rules and regulations.  These are more specific around a particular type of expenditure—these are handled case by case.

“Decision-making tree”—the documents help guide decisions made about allowable expenses under Medicaid.

• New brokerage:

Document handed out is FYI. This was what was used for originally soliciting proposals.  At least one new brokerage will be needed in the near future.

The metro and mid-valley areas are where the new brokerages will most likely be needed to serve customers.  The state is reviewing brokerage capacity at this time. There are a number of options. Brokerages might stand alone, or they might be part of another organization; they may serve between 350 and 700 people/customers, etc. 

Action: Rough data will be available at the next meeting (via Mike.) 

This should be part of the continuation of Staley, not a new budget package. Mary Lee will clarify this with her team.  Implement 10^th brokerage into ongoing agreement—again, this will be clarified.  Tim Kral asked if the RFP for the new brokerage would go to DAS?  Mary Lee answered yes, it will and the process has changed.  (This is different than professional services.)

Action: Mike stated the numbers will be pulled from CPMS report in December and will be brought to the next SIG meeting.

Action:  A small group will form to focus on addressing this issue.  Dan Peccia, Margaret Theisen, Marcie Ingledue, MaryLee Fay, Scott Pelham, Pam Ring, Tim Kral, Nona Scott, and Judy Cunio volunteered to be part of that small group.  The meeting will be held at the Arc of Oregon Thursday, January 5^th, 1:00 – 3:00 p.m. and Mike will remind participants of the meeting date and time, and any additional information needed.

Rates workgroup:

Tim reported the group met.  Issue: is there a need for changes in the rates?  All groups were represented except the self-advocate stakeholder group.  Providers experience rate issues, but if there isn’t sufficient data from customers or funders…is this really an issue?  Not at this time; more data is needed.  Mary Lee said the data would be available—MMIS would be later than eXPRS 2.  Perhaps by the next fiscal year the data will be compiled and useful for substantiating the need for changes in the rates.

Providers may be providing services at a loss, which is a different issue than the rates being off—providers will have to address the issue independently.  The rates seem to be working for customers, according to Margaret.

Caseloads:

Mike said the personal agent caseloads work group is scheduled to meet in January.. This will be discussed further at the next meeting.

Quality Assurance

Sandy was to pull together an overarching group to make recommendations about creating a taskforce similar to the SIG focused on the comprehensive system. The group has not met at this time.  No county representative was available to give a report.  This discussion item was tabled for a future meeting.

Tim—EOS report will come out soon, but it appears to impact comprehensive services more so than brokerage services.  Tim will get the report to the group.

SIG QA responsibility:

Mike stated the SIG is responsible for reviewing data and getting feedback back to the state.  Bill noted that SIG will focus on having an annual meeting to review those action items and data in more depth, and from that take recommendations to the state DHS-SPD.

Mike noted that customer satisfaction isn’t consistent at this time and the state is looking ,through a CMS grant, receiving  a consistent consumer satisfaction tool and procedures for gathering satisfaction information. The state is looking at other methods for measuring outcomes of support services brokerages—are customers getting what they want?  How do we track that?

“Oregon’s Personal Outcome Statements and Indicators for Brokerage Services” document reviewed.

No field reviews have occurred since the last meeting.

Certification reviews will be discussed at the March meeting.

Benchmarks:

Brokerages are striving to be the best they can be—the state developed benchmarks for the brokerages to work off of, as a jump off point for improving quality services delivered to brokerage customers.

Policy discussion:

The Policy discussion occurred earlier “Role of the Family.”

Other (broader)

Staley Report:

Mike noted the state does an annual report to the plaintiff group.  It was noted that it would be nice to also have a broader report to send to the community—what is happening, what has happened… Mike asked the group to come back with ideas that people can react to.  Personal stories about what the brokerages are all about would be ideal. 

Action: Kathryn will gather some recommendations and the group can work from there.

DAWGS letter:

SIG members received a letter in August from a group called DAWGS.

Action: The group decided not to respond; there is nothing additional to add at this time.

MMA update:

Cynthia announced there will be a couple opportunities to gain more information about the Medicaid Modernization Act.

Cindy Becker (cindy@beckercompany.net) is the main contact person for these events.

Date: Dec. 10^th

Time: 9am to 4pm, with presentations at 10am, 12pm and 2pm

Locations: Portland Convention Center and Columbia Hall at the Salem Fairgrounds

10 plan agencies will be represented—giving information to people about the services.

Tables available at events to groups at no cost.

The Social Security Administration will be at both locations on the 10^th of December.

Will people be able to enroll into a program at the event?  Probably not then and there; this will be primarily a time for information.  Heads up to the brokerages: customers may need assistance with enrolling into a new prescription drug coverage program.

The events are open to any interested person.

OHSU will host another gathering on Jan. 14^th—it will also be an open event—depends on how well the other two gatherings go.

Next meeting:

Bill suggested we set up the entire 2006 calendar for the meetings.  SIG meets every other month.  The group will meet:

January 19, 2006 (third Thursday of the month)

March 16, 2006 (third Thursday of the month)

May 24, 2006 (fourth Wednesday of the month)

July 28, 2006 (fourth Friday of the month)

September 28, 2006 (fourth Thursday of the month)

November 9, 2006 (second Thursday of the month)

The meetings will continue to be at the RCO brokerage.

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