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Official Minutes
Resource Connections of Oregon
Salem, Oregon 97305
May 23, 2008

• Next meeting is scheduled for Friday, July 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.
• Meetings for 2008—September 26, 2008, November 19, 2008                         

In Attendance:  Cynthia Owens, Judy Cunio, Carol Simonds, Cindy Helvington, Arlene Jones, Marcie Ingledue, Nona Scott, Bill Lynch, Pam Ring, Mike Maley, Mike Parr, Kathryn Weit, Dan Peccia, Bev Herrin, Tom Racioppo, Heber Nelson, Leah Craft, Diana Buell, Jim Wrigley, Dianne Turner, Gabriel Bolivar, Tim Kral

Meeting was called to order by facilitator, Bill Lynch, at 9:35 am.  Minutes taken by Arlene Jones.  County representatives Jasper Smith, Kathy Drew, and Patrice Botsford were unable to attend.  Conversation will be held at the County Developmental Disabilities (DD) case managers meeting as to county representation on the SIG.  Dan Peccia expressed that a group of Metro providers, representing smaller agencies and independent contractors, has indicated interest in sending a representative to the SIG.  This individual would replace the position vacated by Kathy Holmquist.  Dan will interface with the Metro group and send the contact information to Kathryn Weit.  The Customers/Families/Advocates stakeholder group is also looking for another family representative and is open to recommendations.

Introductions and Announcements
Introductions were made.   It was announced that the Oregon Advocacy Center has revised its name to Disability Rights Oregon, aligning with the national organization.  Unveiling of the new logo and name occurred at their open house held May 21, 2008.

The 8th Annual Pacific NW Conference on Dual Diagnosis, sponsored by the Oregon Rehabilitation Association (ORA) will be held on June 12-13, 2008 at the Sheraton Portland Airport Hotel in Portland.     

Review & Approval of Minutes
The March 23, 2008, minutes were approved by consensus.  Final version will be posted on The Arc of Oregon website. 

Success Stories
Resource Connections of Oregon (RCO)
Bev Herrin related how a Personal Agent (PA) at RCO was able to assist a customer in high school transition, who was experiencing both a contentious Individual Education Program (IEP) process along with parents going through a divorce.  The PA was able to facilitate two person-centered planning sessions, so as to accommodate each side of the customer’s family.

Also related was the story of a customer who had lost custody of her child, and was working to access the system so as to be able to see the child again.

Self Determination Resources Inc (SDRI)
Dan Peccia spoke on the success of a PA from SDRI, being able to advocate towards having customers access a newly formed cheerleading program for people with disabilities in Oregon—StyleShock Cheerleading.  Initially the program was to have an upper age limit, but with coaching from the PA (as a dream of one customer was to be a cheerleader), this was removed.  The no-fee program is staffed by volunteers.  Participants range in age from 6 years on up.    

Open Mic
Mike Maley spoke on the success of getting to the work being done by brokerages.  Pam Ring related how 27/28 year olds in their area are accessing support services and the individuals are excited about it.

Monitoring/Updates
SPD Updates

• Survey of counties/brokerages re:  Roadmap (see Action Item)

In response to the action item posed as to a polling of the number of “A Roadmap to Support Services” manuals in County and Brokerage possession and whether distribution of the printed manual or downloaded PDF is occurring at each referral, the following information was received from the state.  Half of the counties are actually using the manuals.  All brokerages get the manual into the hands of customers once enrolled in the brokerage.  Data was not obtained as to how the manual is used in presentation to customers or how the manual is used by Counties prior to referral to the Brokerages. 

It was expressed that “A Roadmap to Support Services” is utilized in a number of outreach activities.  Reprint of the manuals is not an option for the state.  

• Increase in Plan Benefit Levels

There will be an increase of up to 10% for all plan benefit levels except the maximal Base Plus level so as to bring provider rate guidelines for Support Services commensurate with the Comprehensive side.  Implementation will occur in October 2008. 

Mike explained the state’s recognition that plan amounts spent by customers (actuals) as being different from projected plan amounts.  On average, actuals are less than projected plan amounts.  The dilemma is that these funds end up being looked at as available for other areas, although there is the expectation of use for support services.  Also, there is an inability to enroll more individuals, along with an overall program cap.  The provider rate increase for Comprehensive outside of the COLA created stress for provider capacity as this same pool is part of the provider base for support services customers. 

Program change decision by the state was to reinvest the funds to raise all customers’ plan caps up towards 10%, except those receiving the maximal Base Plus, as this would be serving the greater number of customers.  As the maximal program cap level is approached the percentage decreases.  These plan benefit level increases were not mandated to go through providers, so the funds could be used for different supports and/or providers.  This would have a different impact for those customers in the lower benefit plan levels, (further away from the maximal cap).     

During a conference call, held by the state with brokerages and advocates, it was expressed that 97% of customers would benefit and 3% of customers could lose days of service, in some cases up to a month of service annually.  The maximum cap can not be changed.  It was estimated that less than 10% of Base Plus customers might be impacted, although not all use provider agency services.  The issue has been broadly discussed. 

Suggestion was made as to the possibility of reducing impact on the 3% by prioritizing those individuals for Comp 300.  Question was raised as to whether the support services waiver rule revision would address the increases in the benefit plan levels.  Response was that strategically, the rule language would be crafted so that rule and waiver amendments would not be needed each time a COLA change is instituted.  Question was also raised as to whether the ratio of actuals and plan dollars would remain the same.  Response was that yes, historically this has remained the same.

The state is intending to put together strategically related (policy and practice) issue briefs.  The issue briefs would be reviewed by the brokerage directors first, and then brought to the SIG to facilitate the bigger discussions.  Outcomes would allow for future framing.  Examples of how other states are responding to these issues would also be provided. 
Six issues: 

• Supplanting—as in when do you pay a family member out of support services dollars for things family is already giving;
• Family members as care givers—how do we ensure quality within the family home with regard to Medicaid services;

• Family members as a paid care giver and not filling obligations;
• Family home situation which is jeopardizing the customer’s wellbeing;

• Health and safety issues—addressing in-home, community-based services which are at the same time customer driven;
• How do we know that services are actually being given Service Monitoring;
• Program expectations—example situation given, where annually there is a level of care (LOC) determination so as to ascertain eligibility for waiver, but what if the program participant is unavailable and/or does not want to participate;
• Customer as the employer;

Discussion followed.  Consensus agreement as to having these six issues placed under the Complex Issues Discussion portion of the agenda.  Consensus of the group was to also start with (2) Family members as care givers—how do we ensure quality within the family home with regard to Medicaid services.  Looking at this issue would allow for inclusion of information available through the Developmental Disabilities Quality Assurance Committee (DD QAC). 

• New Brokerage

It was reported that The Arc Brokerage Services (TABS) is on schedule, with Jennifer Bickett as Executive Director and Tricia Rosenkranz as Lead PA.  Recommendation was made to extend an open invitation to all brokerage directors as to attending the next SIG meeting, especially those associated with the newer brokerages.
 
ACTION ITEM—Brokerages will extend open invitation to all brokerage directors as to attending the next SIG meeting, especially those associated with the newer brokerages.

• Support Services Rule

Mike Parr gave an update on the support services rule.  With regard to the Centers for Medicare and Medicaid Services (CMS) review of the abuse and grievance process, permanent changes made, will be effective July 2008.  Currently the Rule Workgroup is at the point of looking at the broader list of issues and working on the wording of the rule (rule updated as changes occur in the waiver).

Through work being done by the Rule Workgroup, it is recognized that there are several items which are beyond the scope of the group.  Examples given—(1) Incident Reports, where PAs know what incident reports are and how to submit them, but what triggers submission of incident reports is less clear; (2) Identification of limits to PAs involvement in customers’ lives.  In trying to make this an on-going process, the limiting factor would be commitment by individuals serving on the Rule Workgroup.  Recognition was made as to the importance of reconvening the Rule Workgroup to address identified items as they surface or to deal with the broader issues.  Recommendation was made for continuation of connections with the SIG.  Mike has crafted a document listing identified issues.         

• Comp 300

Diana Buell reported that regions are meeting routinely.  With respect to building capacity, people in the different regions are expressing their desire for supported living.  Duplexes and multiplexes allow more flexibility for those wanting more independent living.  Smaller counties where initially a provider base was nonexistent have been able to develop, and are currently expanding capacity.

Question was raised whether observations are occurring related to potentially more family involvement with a different population (foster care and supported living) coming in.  Response was no that this was not the case.

Brokerages expressed that there were issues between regions, counties, and brokerages, in that brokerages are not involved in the discussions, although brokerages would be involved with providing supports (supported living in the family home, because the customer did not want out of home placement).  With regard to identification of all individuals who would be eligible for Comp 300, that number is not finite. 

Heber Nelson (SPD Housing Section Manager) briefed the SIG on various locations where multi-individual habitation is available.  Question was raised as to whether these locations were the only residential options being offered.  Issue was raised as to whether individuals were really being given choice.  Control of housing dollars occurs at the local level.  With regard to person centered planning for Comp 300 individuals, this occurs at the Community Developmental Disabilities Program (CDDP) level, and it was not known whether it would be a formal process.   
     

• Employment Initiative

State is being driven by the Employment Task Force via the national, Employment First Policy—getting employment in an integrated setting as a primary consideration.  There will be an August unveiling by the Employment Task Force.  This is a statewide policy not specific for support services or comprehensive.  How does this dovetail with customer choice and self-direction?  Within support services, this raises issues of care giving (families remaining as caregivers) versus the desires/supports of customers.  Recommendation is to have this as an agenda item for the next SIG meeting. 
 

• Grievances and Fair Hearing

Most of the grievance and fair hearings have centered on implementation of the Base Plus tool.  Question was raised as to whether there are Base Plus operations guidelines which the SIG has not seen or is unaware of, including allowable services.  It is important that the SIG be versed of the rules and guidelines.  It is unclear as to the expectation of situations for obtaining base plus—those issues should be reflected both in the ISP and Base Plus plan.  Example given was with regard to major behavior issues.  Brokerages do not have the authority to remove a customer out of the home.

ACTION ITEM—Mike Parr to obtain and send the most current Base Plus guidelines to members of the SIG. 

• Provider Sanctioning

It is recognized that guidance with regard to provider sanctioning is an area of weakness.  Once a provider has been sanctioned, the provider can appeal.  How does one know if a provider has been sanctioned?  Most times this is unknown by individual family members.  Included on the provider application form is a question referencing provider sanctioning.  But when the individual is a family member, how is the situation judged?  What are the guidelines? 

Disability Rights Oregon (DRO, formerly Oregon Advocacy) issues around rule of grievance and fair hearings, where there is not a clear path of the formal grievance process and waiver hearing with regard to hearing of choice.  Forms review is continuing for readability by families and customers.  There are also SPD-wide issues dealing with the various other Medicaid waiver rules because there are differences between the different department waivers.

• Enrollment Data

4889 customers in brokerages during the month of May, with 4874 as the end of May actual.     

Customer/Family/Advocates
Cynthia Owens reported that the person-centered employment development video is expected to be completed within the next week.  The DVD is 45 minutes in length and would be available for use by a wide range of individuals, including family members, brokerage staff, vocational rehabilitation (VR) counselors, transition teachers, and education staff.  As it is unavailable today, during lunch, the DVD taping of the Kathie Snow presentation from the 2008 Direct Supports Videoconferencing will be shown.     

The one day SIG PCP Training is scheduled for Tuesday, October 14, 2008.  Formatting will be similar to trainings for the 2008 Direct Supports Videoconferencing with broadcast to 10 sites around the state from Chemeketa College in Salem.  Presenters will include Creative Supports, Inc (CSI) staff, Michael Smull and Self Advocates As Leaders (SAAL).   

Brokerages

• Consistent statewide logo, terminology, info (see Action Item)

Brokerage directors have been informed of the recommendation to use consistent statewide branding (SDS logo), along with use of “support services for adults with developmental disabilities” over the terminology “brokerage.” 

Brokerages related an incident where a brokerage customer with a medical condition had gotten ill.  The customer’s provider, a domestic employee (DE), had taken the customer to the hospital, but the customer’s condition was misdiagnosed.  Subsequently, the customer died.  County investigation of the incident accused the brokerage of not monitoring the customer’s health and safety.  Issue involves the application of comprehensive level of expectation to brokerage in-home support services.  Meetings are scheduled for state, county, and brokerage to hold discussions.   

Counties
No report.

Traditional Providers
Tim Kral introduced Gabriel Bolivar, who replaces Caryl Knudsen as a provider representative on the SIG.  Tim will be sharing an analysis of the VR report (relevant pages of the report) to the SIG.  The VR report, as well as the opportunity to comment is available on the DD Coalition website    

ACTION ITEM—Tim Kral to send SIG members, an analysis of the VR report, including pages of the report relevant to the SIG. 

Independent Providers
A letter from Kathy Holmquist was shared with the SIG, citing non-face-to-face contact with respect to job development/coaching, and nonpayment due to vacancy issues.    

Complex Issue Discussion and Action Steps

• Responsibility for use of public dollars versus values of self-determination and choice:  Where do we draw the line?

• Training:  providing information and training to meet PATH plan recognized priority. 

Tabulation of various trainings were distributed—one from the DD Coalition and another from the Capacity Building Stakeholder group (framing).  None of the trainings listed is specific to support services.  It is recognized that we have struggled with the issues of trainings for customers and families.  As a group we need to figure out what we want to accomplish.    

What, who, and how.  Much discussion followed.  It was noted that there are materials which have been developed and that regional training entities used to share what each had with each other.  Question was raised as to the value of having a training website which would house materials, power points, etc, such as the Disability Compass website (www.disabilitycompass.org) or the Quality Mall website (www.qualitymall.org).      

Dianne Turner volunteered to format charting table so as to initiate gathering of trainings and educational materials.  Wide topic range—specific disabilities, personal trainings, resource trainings, professional tools, what do housing resources look like, local family training, basic information on Medicaid (what it is), basic information on autism, client as an employer and identification of subtopics with regard to client as an employer.  Dianne will send table out to SIG members, and SIG members will in turn send information with regard to trainings and educational opportunities back to Dianne for collection.  A smaller group would then review the materials received.  

Members of the smaller Trainings Review Workgroup include Dianne Turner, Karen Craven, Judy Cunio, Pamela Winfrow, Tom Racioppo, Arlene Jones, and a brokerage representative.  This group would meet in Salem on July 25, 2008.

ACTION ITEM—Dianne Turner to format charting table to initiate gathering of trainings and educational materials, and send out to the SIG.  SIG members to fill in table with trainings, etc that they are familiar with and send back to Dianne.

Quality Assurance

• Bi-annual review of Serious Event Review Team (SERT) Data

Eva Kutas will be able to come to the next SIG meeting with PSI and SERT data.

• Field Review Findings, June – November 2007

The Field Review Findings, June – November 2007 document was reviewed by Tom Racioppo.  The benchmarks were originally set by the SIG for the 9 brokerages.  The data listed are composite numbers, although for some of the categories, a range exists.  Areas of low benchmark have been addressed with trainings or through liaisons.  Some methodology was changed, so just because a percentage decreased does not mean that lowered performance occurred.  The number of files reviewed was decreased, since removal of files affected brokerage functioning when the review was being done. 

It was noted that the Consumer Satisfaction Survey does not measure the disaffected.  There has been 46 new staff since the previous review.  With regard to trends, an increase of provider sanctioning (fraudulent filing, financial fraud) was noted. 

Next steps were included in the document.  The Tools for Personal Agents webpage can be found at http://www.dhs.state.or.us/spd/tools/dd/bpa/.

Question was presented to the SIG as to whether the benchmarks should be raised, especially if percentages achieved have consistently been above benchmark.  Consensus agreement to raise benchmarks for 1.3.1 and 2.3.1 to 95% and keep the rest the same.  Other recommendations were:  (1) to list the separate percentages for ‘yes” and “it’s okay” for the customer satisfaction survey; (2) to include the negative on the satisfaction survey—‘fewer than X will say that they are dissatisfied.’

With regard to Emergency Preparedness, Janet Straw was assigned as the point person.  Question was raised as to status.  Janet could come and speak to the SIG on overall disaster preparedness and also personal emergency preparedness.  What is the role of brokerages with regard to checking on customers?  Who holds responsibility when the individual is living independently?

Review Meeting and Plan Next Meeting

• Next meeting is scheduled for Friday, July 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.

• Identify agenda items for next meeting:

• Employment Initiative
• Agency with Choice Workgroup Report (?)
• Bi-annual review of Serious Event Review Team (SERT) Data (Comprehensive and Support Services)
• Bi-annual review of Protective Services Investigation (PSI) Data and Information (Comprehensive and Support Services)
• Emergency Preparedness—invite Janet Straw to speak on this and personal emergency preparedness
• Complex Issue Discussion and Action Steps
• Responsibility for use of public dollars versus values of self-determination and choice:  Where do we draw the line?
• Training
• 6 issues brought up by state, of which the first ( ٭ ) was prioritized for discussion:
• Family members as care givers ٭ —how do we ensure quality within the family home with regard to Medicaid services (family members as paid care giver and not fulfilling obligations, family home situation which is jeopardizing the customer’s wellbeing)
• Supplanting—as when do you pay a family member out of support services dollars for things family is already giving;
• Health and safety issues—addressing in-home, community-based services which are at the same time customer driven;
• How do we know that services are actually being given Service Monitoring;
• Program expectations—example situation given, where annually there is a level of care (LOC) determination so as to ascertain eligibility for waiver, but what if the program participant is unavailable and/or does not want to participate;
• Customer as employer.

PARKING LOT

• SERT data reports for Support Services and Comprehensive In-home Support Services to be revisited on a bi-annual basis.  Next reporting scheduled for—July 25, 2008
• Information from Eva Kutas on Protective Services Data and Information (Comprehensive vs. Support Services) on a bi-annual basis.  Next reporting scheduled for—July 25, 2008
• Caseload Ratio Workgroup
• Inadvertent foster care development
• Order of Enrollment (in year prior to end of roll-out)
• Emergency Preparedness presentation by Janet Straw

Adjournment

• The meeting was adjourned at 2:27 PM.   

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