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Official Minutes
Resource Connections of Oregon
Salem, Oregon 97305
November 30, 2007
- Next meeting is scheduled for Friday, January 25, 2008, at Resource Connections of Oregon in Salem from 9:30am – 3:00pm. The Customer/Family/Advocate group will meet from 8:30am – 9:30am.
- PATH Planning February 20, 2008 with Jack Pearpoint and Lynda Kahn, location and time to be determined.
- Meetings for 2008—March 19, 2008, May 23, 2008, July 25, 2008, September 26, 2008, November 19, 2008
In Attendance: Cynthia Owens, Judy Cunio, Cindy Helvington, Carol Simonds, Arlene Jones, Marcie Ingledue, Nona Scott, Bill Lynch, Dianne Duerscheidt, Bev Herrin, Dan Peccia, JoAnne Fuhrman, Dawn Andersson, Jim Wrigley, Mary Lee Faye, Mike Maley, Kathryn Weit, Kathy Drew, Patrice Botsford
Meeting was called to order by facilitator, Bill Lynch, at 9:38am. Marcie Ingledue served as facilitator for the afternoon.
Introductions and Announcements
Introductions were made. Cindy Helvington announced that Self Advocates As Leaders (SAAL) will be moving their office to the Oregon Technical Assistance Corporation (OTAC) on December 13, 2007.
Bill announced that there will be a public meeting on December 6, 2007 from 9:30am – 11:30am at the Office of the State Fire Marshall, 4760 Portland Road NE, Salem, 97305. DHS leadership, the Governor’s Office and members of the Legislature have been invited to brief advocates and concerned citizens about the health and safety issues of people with developmental disabilities raised by the Oregonian.
Cynthia Owens brought holiday treats for everyone to enjoy at the lunch break.
Request was made that stakeholder groups identify their representatives and send updated contact information to Kathryn Weit. Both the Self-advocates and Families stakeholder groups requested assistance from brokerages to identify individuals for their groups.
ACTION ITEM: Stakeholder groups identify their representatives (2 designated and 2 alternates) and send updated contact information to Kathryn Weit.
ACTION ITEM: Request from Self-Advocates and Families stakeholders groups for assistance from brokerages in identifying individuals for representation.
Review & Approval of Minutes
The June 22, 2007 minutes were approved by consensus. Final version will be posted on the Arc of Oregon website.
Monitoring/Updates
SPD Updates
- Data Report: Enrollment/trends, etc.
Reporting for Period 24, shows 5497 individuals enrolled. Beginning of November 2007 marks the 6 year anniversary of brokerage enrollments. Notation was made that the enrollment is not a trend, as this has been a planned process. Although a lot of work has been accomplished, more is anticipated through the end of the rollout. During the last year of managed enrollment, the enrollment categories of general waitlist and the 18-21 yr olds will need to be revisited.
A continued consistency of trends is seen. The increase in terminations and entry into the Comp 300, is an artifact of the Comp 300 enrollments during the particular time period. The page titled, “Enrollment and Termination Summary by Brokerage” has errors associated with it and the State will send out an updated version electronically.
ACTION ITEM: Updates and corrections on the “Enrollment and Termination Summary by Brokerage” page of the “Settlement Data Update” to be sent electronically from the State.
- CMS Corrective Action Plan re: grievances and fair hearings
Dawn Andersson reported that the forums for the grievances and fair hearings process have been occurring. The forms and materials are still being worked on. Question was raised as to whether an informational/ educational document has been developed for customers and families. Discussion followed. Recommendation was made that such a document be made available for review by self-advocates and families of the SIG prior to distribution.
With regard to other communication with the Centers for Medicare and Medicaid Services (CMS), waiver amendment was submitted and approved by CMS for cost of living adjustment ($21,119) for support services. Although the amendment for the comprehensive side has been submitted, approval has not been received as of this time.
The General Accounting Office (GAO) has not sent a report from their review visit, which was not an audit. Departmental follow-up will occur after January 2008, if a report is received before then.
- New Brokerages’ Enrollment Schedule
The new brokerages have begun their enrollments, one in October and the second in November. These brokerages will be at near full capacity by June 2009. Independence Northwest is housed in the Metro area covering Multnomah, Clackamas, and Washington Counties (with 450 capacity). The second brokerage is in the Mid-valley area of Lane County, also serving Benton, Linn, Polk, and Marion Counties (with 350 capacity). Customer choice of brokerage remains at the same standard as previously. Recommendation was made that in locations where there are multiple brokerages, Seniors and People with Disabilities (SPD) convey to Counties as to informing incoming customers that although they may be assigned to a brokerage, there is a choice of which brokerage they could use.
Recommendation was made that brokerages provide outreach to transitioning high school students.
Issue was brought up as to the numbers of individuals enrolled in active case management who are not in service and turn 18yr by June 2009. Adjustments will need to be made in brokerage capacity levels or the development of another new brokerage. Anecdotally, 57% are between 18 and 25 years of age. Over the next few months, work will be occurring to look at these numbers.
- Comp 300 Workgroup Report
Concern had been raised as to the small number of people involved with making the determinations of who would receive Comp 300. Regional meetings have occurred with the counties at the director level to review the recommendations of the planning group. Fact sheet was distributed and counties would involve representation by families and brokerages, with regard to implementation.
Discussion occurred with regard to Comp 300 determinations and strategic building of capacity especially in rural areas. Looking at community unmet needs capacity—in some areas a provider organization may need some stability by being able to serve more than just 1 or 2 customers, or areas where individuals are having to leave because originally the community does not have the need for providers, so there are none.
- Plan Authorization Pilot Project Workgroup report
With regard to plan form authorization, approval has been received from CMS for this point of change. Discussion followed with regard to the assumption that Clackamas County was testing this type of project. The State responded that as of this time, no county is conducting a pilot project, although Clackamas County would have the right characteristics for a pilot to occur. As no county is doing a pilot, no timeline has been put in place.
- Conflict of Interest form utilization plan
It was believed that the SIG had addressed this through the development of a recommended process, which would ask families/caregivers some questions, specific around the use of monies, paying the family caregiver to implement the plan. The areas of practice versus rule and authority did not fall into the role of the SIG, so the document stating the process was given to the State. No further progress has occurred. The State will have a point person to meet with Kathryn. Discussion followed with recommendations to have broader SIG discussion and obtain more feedback from brokerages and PAs.
ACTION ITEM: Send out notes and documents associated with the Conflict of Interest plan which had been developed, so as to bring back to discussion by the SIG.
Mike Maley requested the formation of a workgroup to discuss issues related to the incorporation of individuals with developmental disabilities, not just mental retardation (for both comprehensive and support services), with regard to crisis. The workgroup would consist of 3 representing brokerages, 3 representing families/self-advocates, 3 community developmental disabilities program (CDDP), 1 regional crisis, 1 state. This workgroup would be preliminary to a rule making group, with the first meeting set for January 2008. Jim Wrigley, Cynthia Owens, Nona Scott, and Cindy Helvington agreed to participate on this workgroup.
Attention was called to the power point, Support Waivers, by Gary Smith, Human Services Research Institute (HSRI). Findings stated that the interface of support service waivers with comprehensive services serve as a difficulty for all states. Conflicts are also an issue. Connecticut is higher in cost for all services compared to Oregon and should be a state to observe with regard to implications of cost for services (as a policy option package) on the impact of how services are looked at.
Issue Discussion and Action
- Agency With Choice Workgroup
Dan Peccia reported that this group has not met as of this time. Recommendation occurred as to a cross comparison of Agency With Choice to what is occurring on the Aging and Physically Disabled (APD) side of SPD, where there is a commission and training has been developed. Request was made that individuals from SPD/APD present information to the Agency With Choice Workgroup. As budget packages arise in May and June, what arises from these discussions can affect budget associated policy.
It was also noted that Acumen is also providing a way for providing workman’s compensation insurance for individual families.
ACTION ITEM: Dan to send a message to reconvene this workgroup, linking up with presenters from SPD/APD.
Monitoring/Updates—continued
Brokerages
- Customer satisfaction surveys: standardization of forms and return rate needed for statistically valid data
The annual customer satisfaction surveys used by brokerages include a list of required questions, along with others that individual brokerages use. As far as the return rate needed for statistically valid data, it was reported that 14% for support services (for 1000) and 7% for comp side.
The results from the DD In-Home Services Consumer Satisfaction Survey 2007 (14 questions) sent out through SPD have been received and are being tabulated. The outcomes will be shared with various stakeholders including brokerage directors, CDDP program managers, SPD internal staff, DD Quality Assurance (QA) Committee, SIG and with local QA Coordinators. Reports will be available electronically on the SPD website under waiver services. http://www.oregon.gov/DHS/spd/qa/home.shtml#ssadults
Brokerages reported that their other survey would be conducted. This is the expanded in-depth questions conducted face-to-face with 2% of customers of all brokerages, in a longitudinal study. Results of this survey are tabulated through an individual at the University of Oregon. Dawn requested that the data collected through this survey be received by her department.
Counties
New county representatives to the SIG were Kathy Drew from Deschutes County and Patrice Botsford from Multnomah County.
Customer/Family/Advocates
- Report on draft training plan
$15,000 of the state general fund is budgeted a biennium towards trainings for customers and families. If trainings were to also include brokerages and PAs, then Medicaid match of $15,000 would also be available. A proposal was distributed to SIG members. This was the result of a combination of discussions by the Statewide Trainings Workgroup and also at the DD Council.
Although a lot of best practices were occurring within brokerages across the state, sharing and interchange of this information was not occurring. Previous networking had occurred with “quarterlies” meetings of the past, but these had been funded through Oregon Health Sciences University (OHSU) and were no longer available. It was proposed that the funds be used to support an annual brokerage best practices training where information would focus on best practices by brokerages in providing service to families and customers. Topics and target audience would be brokerage board (families and customers/self-advocates) and PAs/brokerage staff. Other individuals, such as active family members and customers, would be welcome to attend, so this would not be limited to just brokerage board members.
Notation was made as to the importance of continued promotion and use of “A Roadmap to Support Services” manual, along with the power point materials which had been developed by the Roadmap Trainings Workgroup. The power points are located on the Oregon Council of Developmental Disabilities website. http://www.ocdd.org/
A second portion of the proposal for use of the funds was in support of the Medicaid Infrastructure Grant (MIG) “Help Wanted—Getting A Job.” The MIG has decreased the amount to $5000 from what was anticipated, so further funding is needed towards development of a video for use in conjunction with the training. The video would be actual/live footage of the 6 hour training, with editing. The material would be used by high school transition teaching staff, vocational rehabilitation, besides other trainers. Discussion followed.
It was recognized that the funding amount would not support both portions of this proposal. Funding support for “Help Wanted—Getting A Job” was asked of SPD and other stakeholders such as the brokerages and CDDPs. Mike stated that he would speak with Sara Kendall with regard to additional funding support. The Oregon Department of Education is being approached also.
With regard to development of a brokerage best practices training, the following individuals will form a workgroup—Judy Cunio, Dan Peccia or a brokerage representative, Mike Maley or a representative from the State, Cynthia Owens, Arlene Jones, Kathryn Weit, Barbara Hedrick, Cindy Helvington or a representative from SAAL, Dianne Duerscheidt, and a Council representative. Cynthia will serve as convener.
ACTION ITEM: Cynthia to convene the Brokerage Best Practices Annual Training Workgroup to work on the annual training, set a time or date, location, agenda, and budget draft for training.
Providers
- As Tim Kral was not in attendance, information on this would be obtained from him at the next meeting. Brokerage directors were asked if they were hearing about any issues related to the absentee policy. Except for independent contractors and domestic employees who could not access this policy, there did not appear to be issues with its usage. Utilization was not necessarily high.
Strategic Discussions & Quality Assurance
- SERT (Serious Event Response Team) data reports for Support Services
Dawn reported on Serious Event Response Team (SERT) data. A data entry issue was discovered in that some brokerage information was being combined with CDDP’s. This is being addressed for future data entry of brokerage serious events. A matrix chart was distributed which delineates what should and should be considered as SERT data. It was recognized that deaths listed could be attributable to natural causes. With regard to financial exploitation, there appears to be a loophole in the support services area. Notation was made that as this would require statutory change, some coverage is afforded with sanctioning of providers or decreasing funds paid.
Question was raised as to the difference between SERT and sanctioning. Sanctioning relates to incidents which area “not quite criminal.” Examples given included overbilling, Medicaid fraud, DUI record, licensing and insurance not current.
Recommendation was made to have SERT data reports continued on a bi-annual basis, along with Protective Services reporting by Eva Kutas. The goal is for understanding of information.
Retreat Committee Reports
Erin Graf was not present. Brokerages will contact Erin with regard to the Caseload Ratio Workgroup. Erin is now the assistant director at Independence Northwest brokerage.
ACTION ITEM: Dan to contact Erin with regard to convening or reporting on Caseload Ratio Workgroup.
Review Meeting and Plan Next Meeting
- Next meeting is scheduled for Friday, January 25, 2008, at Resource Connections of Oregon in Salem from 9:30am – 3:00pm. The Customer/Family/Advocate group will meet from 8:30am – 9:30am.
- PATH Planning February 20, 2008 with Jack Pearpoint and Lynda Kahn, location and time to be determined.
- Meetings for 2008—March 19, 2008, May 23, 2008, July 25, 2008, September 26, 2008, November 19, 2008
Agenda items for next meeting
- Conflict of Interest process and form
- Incorporation of non-MR DD individuals Workgroup
- Agency With Choice Workgroup—update
- Absenteeism data and policy
- Caseload Ratio Workgroup—update
PARKING LOT
- SERT data reports for Support Services and Comprehensive In-home Support Services to be revisited on a bi-annual basis. Next reporting—May 23, 2008
- Information from Eva Kutas on Protective Services Data and Information (Comprehensive vs. Support Services) on a bi-annual basis. Next reporting—March 19, 2008
- Caseload Ratio Workgroup
- Inadvertent foster care development
- Order of Enrollment (in year prior to end of roll-out)
Adjournment
- The meeting was adjourned 1:35 PM.
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