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Official Minutes
October 5, 2006

Staley Implementation Group

Resource Connections of Oregon
Salem, Oregon 97305

In Attendance:  Cynthia Owens, Marcela Tafalla, Kathryn Weit, Cindy Helvington, Judy Cunio, Kristine Merritt, Arlene Jones, Marcie Ingledue, Martha Stracener, Margaret Theisen, Mary Lee Fay, Kim Sellman, Erin Graff, Dan Peccia, Mike Maley, Pam Ring, Kathy Holmquist, Pat Allen-Sleeman, Peggy Lovelace, Bill Lynch.

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

 Introductions and Announcements

Introductions were made.  Judy Cunio announced that free Voting workshops will be held next week.  Flyers were distributed. 

Review & Approval of Minutes

The July 28, 2006, minutes were approved by consensus with amendment of recommended changes.

  Monitoring/Updates

SPD Update

Agenda was adjusted so as to accommodate schedules for Mike Maley and Mary Lee Fay.

• Data report:  Enrollment/trends, etc.

As SDRI is at full capacity, DSI has started services in Washington County and will be serving the SILP customers.  In the tri-county region each county is now being served by two brokerages. 

In examining the Reason for Enrollment report, request was made for defining the 18-21 yrs category according to reason for enrollment and which brokerages these customers are being served by.  Mike Maley will send this information to Cynthia Owens. 

Recommendation was made to invite Eva Kutas to present protective services data and information on the differences between protective services in Comprehensive and Brokerage.  Mike will request that Eva bring copies of the protective services data for the meeting.

Plan projected costs are above $800 per month, with an average of $832 per month.  Actual plan costs are averaging $633 per month.  This is an 11% shift from a year ago, reflecting the shift towards the mid-range ($12,000-$14,000 per year).

• Budget review—Plan costs of above $800 per month include personal care costs.  The budget is tightly aligned.  Projected plan costs in the 2007-2009 budget will not be finalized until the April 2007 “reshoot”.  What has been observed is that actual plan costs are coming in at 83% of projected plan costs.  Budget does not include cost of living consideration.

• Comp 300:  Status—Plans are progressing, with the impression that things are on track for enrollment.

• SILP transfer—Approximately 230 people to transfer into either supported living or support services.  Although it is estimated that numbers will be split 50:50, this is best guess, as it is not known which individuals are Medicaid eligible.  In the SILP transfer process, the most difficult issues have been related to getting benefits counseling initiated and fitting into the time schedule.
• Individuals need to be eligible for both the waiver and the level of care (LOC).  Only 4 individuals did not meet the level of care (LOC) eligibility determination.  Request was made to obtain the LOC determination form.  Mike will send the current and draft revision to Kathryn Weit. 

 Discussion occurred on the Indirect Safety Related Support Appendix A-5 document, which had been distributed to the SIG.  The document is to provide description of the situation when there is no natural (unpaid) support available and support would be paid for with support services funds.  Judy expressed concern with what supports would be available in relation to this document.  The rule is expected to go into effect as soon as November 1, 2006.          

• Status of the conflict of interest statement—The State has not moved on the conflict of interest statement.

• Other—

At Mary Lee Fay’s request for representation from Brokerages with regard to disaster preparation, Margaret Theisen agreed to fill this role.

  CMS is coming in January 2007 to evaluate support services and comprehensiveservices waivers (mid-cycle evaluation), meeting with people and conducting field and site reviews.  The State will have a better understanding of the evaluation by the next SIG meeting.  CMS has contracted with HSRI to review waivers in two states—Oregon and Florida.  Although things are not perfect, what we have done in our state is actually good and Oregon should feel good about their efforts.

  Recruitment efforts are underway for an individual to replace Jerry Stolp, who retires in December 2006.  Vickie Storie retired last week and that position is being posted.  Vickie will be returning for the CMS evaluation.      

  Strategic Discussions

• COLA discussion and recommendation

It is speculated that a 2% increase in the Cost-Of-Living Adjustment (COLA) for both operations and services will be in the budget.  Historically it is always a challenge to get from the legislature.  Need to think about how to apply a cost of living increase, as simply as possible.  Recommendation was made that a workgroup form to deal with logistics considerations.  Cynthia and Judy expressed interest in participating on this workgroup.  Recommendations were made that the SIG should be prepared for a COLA and not wait until the middle of the legislative session to begin logistics considerations.

• Brokerage capacity/size discussion and recommendation

New Brokerage workgroup had met and decision was reached that the new brokerage development be opened to the Request for Proposal (RFP) process and that two brokerages be constructed in the two areas of established need—Portland Metro and Mid-Willamette Valley.  Numbers or timelines have not been established.  Key criteria that had been considered were:  (1) 2009 enrollment numbers were unknown and did not want to max out current brokerages, and (2) need for aggressive enrollment numbers in the 2007-2009 period.  It was noted that a potential problem can still exist in the mid-Cascade region and whether those needs can be met by a single brokerage are unknown. 

  Discussion followed.  Issue was raised as to whether the RFP should be weighted towards stand alone or parts of larger organizations, or weighted towards being able to solve geographic range issues.  It was felt that the brokerages maximum capacity would be maintained at 700, although the maximum capacity issue could arise again.    

Next steps: 

• The current workgroup agreed to continue towards the RFP, with Peggy Lovelace as representing Counties.
• Role of the SIG—Identify critical requirements of the new brokerage that a respondent would need to address.  I.e.—cap number, geography range, stand alone vs. part of larger organization, filling in holes of customer education, role of fiscal intermediary (identification of risk and how to approach issues), knowledge of the 7 core functions, approach to aggressive enrollment schedule and still meeting customer satisfaction.
• Geographic and Maximum Capacity Issue

There was consensus agreement on a 350 minimum and 700 maximum capacity, with two brokerages being developed.  Question was raised as to the possibility of existing satellite station staff transferring into newly developed brokerages, so as to ameliorate the situation of customers and staff leaving existing brokerages.

• Stand Alone options versus Part of a Larger Organization options
• Considerations of what happens with Quality Assurance and questions about ustomer driven governance, agenda of the larger organization not being carried out by the brokerage, organizational flowchart, bylaws, values; criteria versus weighting

• A team of individuals will need to be formed to review the new brokerage RFP’s. 

Monitoring/Updates (continued)

Brokerages

Customer interview questionnaire and Fiscal Intermediary (FI) information follow-up

• Customer interview questionnaire—SIG agreed that there would be value in having a longitudinal study done and recommended that a truly random sampling be conducted within each category.  With regard to prioritizing what questions should be asked in this expanded fashion, on an annual basis, employment and unmet customer were identified as the top two items.
• FI Services—in providing information and education to the SIG, the following items were requested for a presentation:  definition of provider categories (4 are listed in “A Roadmap to Support Services”), OAR’s for specialized FI services that brokerages are responsible for (fixed and variable costs), flowchart of documents within support services from timesheet submission to payment of provider, recommendations from the brokerages to address the issues.  A 30 minute time period would be required for the presentation.

Issue was raised as to the situation of the brokerage providing services for high school transition students where the school system is cutting back on the time that students are being served, especially when school policies stipulate start and stop times of school, etc.  It was emphasized that Medicaid will not pay for services that are school education services.  Discussion followed.  It was agreed that training on high school transition and the reauthorized Individuals with Disabilities Education Improvement Act (IDEIA 2004) was needed for brokerage and county staff.  Encouragement was made to work with Oregon Advocacy Center (OAC) to increase training of county service coordinators and brokerage PA’s, as well as education of families in how to write effective Individual Education Plan (IEP) goals so that schools would follow through on services. 

Oregon Parent Training and Information (OrPTI) is conducting training on high school transition in Salem on October 17-18, 2006.  Cost to brokerage staff would be $50.00.  Cynthia explained that every state has the opportunity to have an Education Training and Information (PTI) Center.  OrPTI assists families of children with disabilities with education and support in IEP’s and other facets of special education.  A calendar summary of trainings was requested of Cynthia.  The Oregon Department of Education (ODE) has a fall conference which will have presentation on the reauthorized IDEA regulations.  Public input by brokerages on special education associated issues and unmet needs can be raised at the State Advisory Council on Special Education (SACSE) meetings.

 It was announced that Daniel Smith is the new Executive Director of DSI, and that May Nelson is replacing Martha Stracener as Executive Director at Inclusion. 

  Counties

Peggy expressed concern with customers declining referral into brokerage services.  It was noted that this has occurred in the past. 

  Customer/Family/Advocates

Items discussed elsewhere in the agenda.

  Providers

Kathy Holmquist requested that information needed from Independent Contractors (IC) be sent through the brokerages through Dan Peccia.  IC retention issues are health insurance and workman’s comp.  In order to secure insurance rate information, need to obtain census data by gender and age.  Perspective pool who would be accessing the insurance needs to number in the 1000.  This information may be of benefit to share with foster care providers. 

 In the budget, ORA is looking at $37 million, with $1.00 per hour increase for direct care, versus $60 million.  Revisions have been made to the proctor care rule.  Families decide with brokerage or proctor care.  Difference from the group home situation is that the facility/provider care agency recruits a foster home and the foster home will provide the in-home care but the brokerage will provide additional supports.  The provider agency oversees the care of the customer in the home.  Provider is licensed and the home is certified. 

SIG Update to the General Community

Recommendation was made that all information to the counties and other mailing lists be updated, as well as information on the Arc of Oregon website.  Request will be made to the State for updated mailing labels or addresses.  Stakeholder groups were also reminded as to the need for broad representation. 

Employment—Supported Employment Learning Network—At SPD, much conversation has occurred to move things forward.  A report from the technical assistance visit will be forthcoming.  It was noted that large companies using on-line application, tend to screen out individuals with disabilities.

ReBar Discussions—The restructuring of individual budgets does not relate directly to the brokerages at this point in time, but it could set the stage for how everyone’s budget gets individualized.  Information is listed on the DD Coalition website www.oregonddcoalition.org, along with each of the workgroups.  Evaluations will be made through a third party.  Assessment is not just for the comprehensive side.

  Agency With Choice Workgroup—An on-going topic, this is the growing issue of a huge workforce that is employed by families and customers, with no liability insurance or workman’s comp.  Currently looking at options and researching what other states are doing.  Workgroup consists of Bill Lynch, Cynthia Owens, OTAC representative, Bev Herrin, JoAnne Fuhrman, Marcie Ingledue, Pam Ring, Dan Peccia, Margaret Theisen, Kathryn Weit, and a self-advocate representative.   

Retreat Committees Reports

Training Committee—Presentation on a portion of “A Roadmap to Support Services” will be held at the Washington County Developmental Disabilities Resource Fair on October 19, 2006.

Caseload Ratio Workgroup—Discussion has occurred on ratios and how to alleviate the PA’s workload.  Paperwork not as big of an issue as previously identified versus the needs of PA’s in other activities.  Approximately 1-3% of customers are requiring up to 40% of the PA’s time and rest of the customers is compliance.  This appears to be true in other parts of the system. Question was raised as to the demographic information of those customers and to whether there should be a separate system for those individuals.  It is unknown as to whether all of the issues are being captured.  The next meeting for the workgroup is scheduled for October 24, 2006.  Request was made of the workgroup to come up with specific recommendations that SIG could act on. 

Review Meeting and Plan Next Meeting

• Next meeting is scheduled for Wednesday, December 13, 2006, at Resource
• Connections of Oregon in Salem from 8:30 AM -3:30 PM.
• Identify agenda items 

• Retreat Workgroups—Training and Caseload Ratio
• Brokerage RFP
• Fiscal Intermediary
• Role of schools responsibility
• Protective Services data presentation by Eva Kutas

Adjournment

The meeting was adjourned 2:05 PM.

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